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68 Cards in this Set

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chain of infection
1. Pathogen
2. Reservoir
3. Portal of exit for the reservoir
4. Mode oftransmission
5. Portal of entry to a host
6. A susceptible host
An infection will occur if the chain remains intact
Nurses follow infection prevention and control practices to break the chain so that an infection will not develop
Breaking the Chain of Infection:
•Cleansing, disinfection, sterilization of contaminated objects (bedpan vs catheter)
•Bathing, skin lubrication, oral hygiene
•Position changes, turning, skin inspection
•Maintaining skin integrity
•Elimination needs, perineal care
•Transporting patients
•Administration of antibiotics
•Covering mouth
Breaking the Chain of Infection:
• Avoid sharing of items between patients
• Dressing changes, handling of exudate
•Bedside unit and room environment
•Drainage bags, maintaining closed systems
•Time and date solutions
•Careful disposal of needles
•Bagging of laundry
•Sterile to contaminated
Breaking the Chain of Infection:
•Clean to less clean
•Order of activities
•Barrier protection, correct donning and removing
•Lab specimens
•Avoid splashing
•Committed equipment
•Standard precautions, and Transmission categories
•Protection of both patient and personnel
•Hand washing
Inflammatory response:
1. Vascular and cellular response- arterioles dilate allowing more blood into local circulation, this increase in blood flow causes the characteristic redness and heat
2. Formation of inflammatory exudates- junk cleared via lymphatic drainage
3. Tissue repair- damaged cells are eventually repaired
4. Localized vs Systemic Inflammation
Inflammatory response is Triggered by:
1)Physical agents
2)Chemical agents
3)Microorganisms
4)Mechanical trauma
5)Temperature extremes
6)Radiation
The inflammatory response is a protective vascular and cellular reaction that neutralizes pathogens and repairs body cells. Inflammation is a protective vascular reaction that delivers fluid, blood products, and nutrients to interstitial tissue in an area if injury
This process neutralizes and eliminates pathogens or dead tissue and establishes a means of repairing body cells and tissues
Local symptoms of inflammation and infection:
- Swelling (edema)
- Heat
- Altered Function
- Redness (erythema)
- Pain or Tenderness
Systemic symptoms of inflammation and infection:
- Fever
- Leukocytosis
- Malaise
- Anorexia
- Nausea/Vomiting
- Lymph node enlargement
Body’s normal defenses against infection
- Primary
1) Barriers against entry into the body such as skin, mucous membranes
2) Body fluids such as sebum, saliva, acidity of stomach secretions
3) Normal flora- Inhibits organism growth, secretion of antibacterial substances
4) Cilia, macrophages, flushing of urine flow
Body’s normal defenses against infection
- Secondary
1) inflammatory response
2)Immune response
What happens when normal flora is lost?
- Antibiotics are not always the answer
- Suprainfection
Body System Defenses against infection:
- Skin
- Mouth
- Respiratory tract
- Urinary tract
- Gastrointestinal tract
- Vagina
Not all inflammation is an infection, but
all infection has inflammation!!
Immune Response:
- Triggered in response to invading microorganism
- Antigen- Foreign material, not normally found in a person’s body that causes an immune response
4 Stages of Infection
1. Incubation period
2. Prodromal stage
3. Illness stage
4. Convalescence
Factors that increase an individual’s risk for infection:
1)Client’s susceptibility to infection- family history
2)Age- infants have few defenses, OA have skin and resp. integrity problems
3)Nutritional status -reduction in protein, carbs, and other nutrients reduce defenses and impair wound healing
4)Stress
5)Heredity
6)Disease process- AIDS, Leukemia, etc…
7)Medical therapies- some drug and medical therapies compromise immunity to infection
Conditions that promote the transmission of nosocomial infection:
1)The use of invasive devices such as IV’s, catheters, syringes
2)Over use of broad spectrum antibiotics
3)Poor aseptic technique or sterile technique
4)Improper hand washing
5)SEE CHART ON P&P pg. 843
MRSA
- Methicillin-Resistant Staphylococcus aureus
- Type of bacteria causes “staph’ infections that are resistant to treatment with usual infection
- The most common mode of transmission is from patients that carry the infection on their body and do not have any symptoms
- The main mode of transmission to other patients is through Human Hands
VRE
- Vancomycin-resistant enterococci
- 2004 CDC data reported 1of 3 infections in ICU was caused by VRE
- Normally present in the human intestine and the female genital tract
- Vancomycin is an antibiotic that is used to treat enterococci and in some instances these enterococci become resistant
- VRE can cause urinary tract infection, blood stream infections and wound infections
Risk factors for VRE
- Persons previously treated with antibiotics
- Persons with prolonged hospitalizations
- Persons with weakened immune systems
- Persons who have undergone abdominal surgery
- Persons with medical devices that stay in for a long period of time i.e. urinary catheters
Clostridium Difficile
- A bacterium that causes diarrhea and more serious intestinal conditions such as colitis.
Risk factors for C. Diff
- Patients requiring prolonged use of antibiotics
- Prolonged Hospitalization
- Elderly
Preventing Antimicrobial Resistance
- Vaccinate
- Get catheters out
- Target the Pathogens
- Access the experts
- Use antimicrobials wisely
- Use local data
- Treat infection not contamination/ Colonization
- Stop antimicrobrial treatment
- Isolate the pathogen
- Break the chain of contagion
2 components of the Immune system:
1. Cell-mediated defenses
2. Antibody-mediated defenses (Humoral)
Cell-mediated defenses
- Also referred to as cellular immunity
- T-cell system
- T cell lymphocytes directly attack antigen and bind it to a receptor site, which releases a chemical that stimulates macrophages to attack antigens
- Loss of this immunity leaves person “defenseless” against most viral, bacterial and fungal infections
Antibody-mediated defenses (HUMORAL)
- Also referred to as humoral or circulating immunity
- Response to antigen
~ B cells activate
~ Differentiate into plasma cells which secrete antibodies and proteins
- Antibody molecules of immunoglobulins
- Immunoglobulins
~ IgM , IgG, IgA, IgD, IgE
2 types of Acquired Immunity
1. Active acquired immunity
2. Passive acquired immunity
Active Acquired Immunity
1. Natural- Antibodies are formed in the presence of active infection in the body, & are life long. Ex: chickenpox
2. Artificial - Antigens (vaccines or toxoids) are administered to stimulate antibody production. Immunity must be reinforced by booster inoculations. Ex: smallpox
Passive Acquired Immunity
1. Natural- Antibodies are transferred naturally from an immune mother to her baby through the placenta or in colostrums. Short acting: 6 months to a year
2. Artificial- Immune serum (antibody) from an animal or another human is injected
Short acting: 2 to 3 weeks
Natural (non-acquired) Immunity
- (aka:Genetic)
- Programmed in the DNA
- Ex: Why dogs don’t get measles
Examples for breaking the chain of infection:
1)Control or eliminate reservoirs- control/eliminate body fluids, drainage, or contaminated solutions
2)Control portals of exit- cover mouth and nose when coughing or sneezing, use contact precautions
3)Control of transmission- client should use their personal items only, hand washing
4)Control portals of entry- maintain skin and mucous membrane integrity, dispose of sharps
5)Protect the susceptible host
WBC count with differential
normal WBC values: 5000-10,000/mm (5-10)
Neutrophils
55%-70%
Lymphocytes
20%-40%
Monocytes
2%-8%
Eosinophils
1%-4%
Basophils
0.5%-1%
culture and sensitivity
- is desirable to optimize therapy:
– Urine, blood, stool, sputum, throat, wound drainage
Effects inflammation and infection have on values:
↑ WBC
↑ ESR- normal: up to 15mm/hr for men 20mm/hr for women
↓ Iron level- normal: 60-90 g/100ml
Abnormal WBC findings
↑ WBC (Leukocytosis)
- Infection
- Leukemia
- Trauma
- Stress
- Tissue necrosis
- Inflammation
Abnormal WBC findings
↓ WBC (Leukopenia)
- Drug toxicity
- Bone marrow failure
- Overwhelming infections
- Dietary deficiency
- Autoimmune disease
- Bone marrow infiltration
Recommended immunization schedules:
• Tetanus-Diptheria – 1 dose booster every 10 years
• Hepatitis B vaccine- Adults at risk- 3 doses
• Influenza – Age 50 and older- annually in fall thru winter
• Phenmococcal vaccine- Age 65 and older- one time dose for most peopel
• MMR (Measles, mumps, rubella) vaccine- One dose (2 for health care workers)
• Varicella (chickenpox) vaccine – 2 doses if over 13 and sero-negative
Centers for Disease Control and Prevention Isolation Guidelines:
Tier One: Standard Precautions
Tier Two: Transmission Categories
Airborne Precautions: Mask, private room, negative pressure airflow
Droplet Precautions: Private or cohort, mask
Contact Precautions: Private or cohort, gloves, gown
Types of exudate
- Serous
- Sanguinous/hemorrhagic
- Purulent
- Fibrinous
- Mucinous/catarrhal
Assessing a patient
-Status of body defenses
-Susceptibility of the patient
-Stress upon the patient
-Heredity
-Disease process symptoms
-Laboratory tests
-Treatment
Patient/family teaching
-Take medication for full course of therapy, even if feeling better
-Report signs of allergy or superinfection (black, furry overgrowth on the tongue, vaginal itching, discharge, loose or foul smelling stools)
-Notify HCP if fever & diarrhea (esp. with blood, pus, mucus) develop
-Notify HCP if symptoms do not improve
Antimicrobial therapy
- Antifungal Agents
- Anti-infective Agents (Antibiotics)
- Antiviral Agents
* Prolonged use of antimicrobials may lead to superinfection with fungi or resistant bacteria.*
Antifungal agents -STOP GROWTH OR KILL FUNGUS
- Skin or mucous membranes (topical or vaginal)
- Systemic (oral or parenteral) -depress bone marrow function ex: amphotericin, fluconazole
- Topical: Cleanse skin first, wear gloves, usually do not use occlusive dressings ex: miconazole, nystatin
- Examples:
– Ophthalmic: natamycin
– Vaginal: clotrimazole, nystatin
- Anti-infective agents- Kill or inhibit growth of pathogenic bacteria.
- May be given as prophylaxis.
- Taken a.t.c.
•Subdivided into categories depending on chemical similarities and antimicrobial spectrum.
– AMINOGLYCOSIDES - Ex: gentamycin
– ANTIMALARIAL – Ex: quinine P
– ANTIPROTOZOAL - Ex: pentamide
– CEPHALOSPORINS - 1st, 2nd, 3rd generations
– FLUOROQUINOLONES – Ex: ciproflaxin
– MACROLIDES – Ex: Erythromycin
– PENICILLINS – Ex: Amoxicillin
– PENICILLINASE-RESISTANT PENICILLINS – Ex: nafcillin
– SULFONAMINDES – Ex: trimethoprim/sulfamethoxazole
– TETRACYCLINES – Ex: doxycycline
– MISCELLANEOUS – Ex: bacitracin
Antiviral agents- Inhibit viral replication
- ACYCLOVIR: Herpes, chickenpox
- FAMCICLOVIR: Herpes
- VALACYLOVIR: Herpes
- ZANAMIVIR: Influenza A viral infections
- CIDOFOVIR, GANCICLOVIR, & FOSCARNET: used for cytomegalovirus retinitis
Nursing diagnosis:
– Infection: risk for
Risk Factors
– Inadequate primary defenses: broken skin, injured tissue, body fluid stasis
– Inadequate secondary defenses: immunosuppression, leukopenia
– Malnutrition, intubation, indwelling catheters, drains, IV devices, invasive procedures, rupture of amniotic membranes, chronic disease, failure to avoid pathogens (exposure), inadequate acquired immunity
Expected outcomes
– Patient remains free of infection as evidenced by normal vital signs, absence of purulent drainage from wounds, incision and tubes during hospital stay
– Infection is recognized early to allow for prompt treatment
Interventions
– Assess for risk factors
– Monitor WBC
– Monitor for signs of infection
– Assess nutritional status
– Assess for exposure to individuals with active infections
– Assess for causes of immunosuppression
Interventions
– Assess immunization status
– Maintain and/or teach asepsis
– Wash hands
– Limit visitors
– Encourage protein and calories
– Encourage fluid intake
Interventions
– Encourage C&DB
– Administer or teach use pf antimicrobial drugs as ordered
– Protective isolation if at high risk
– Protect mucous membranes
– Teach patient and caregivers to wash hands often
– Teach avoiding contact with those with infections/colds
Interventions
- Teach family about protecting susceptible patient from themselves and others with infections/colds
– Teach purpose and technique for maintaining isolation
– Teach taking antibiotics as prescribed
– Teach S&S of infection and when to report to HCP
– Demonstrate and allow return demonstration of high risk procedures that patient will do after discharge
Other potential nursing diagnoses:
- Knowledge deficit r.t. medication regimen
- Noncompliance r.t. medication regimen
- Skin integrity, Impaired r.t. broken area, serous drainage, inflammation
Most common mode of transmission of pathogens is via hands!
- Infections acquired in healthcare
- Spread of antimicrobial resistance
23. Evidence of Relationship Between Hand Hygiene and Healthcare-Associated Infections
- Substantial evidence that hand hygiene reduces the incidence of infections
- Historical study: Semmelweis
- More recent studies: rates lower when antiseptic handwashing was performed
Self-Reported Factors for Poor Adherence with Hand Hygiene
- Handwashing agents cause irritation and dryness
- Sinks are inconveniently located/lack of sinks
- Lack of soap and paper towels
- Too busy/insufficient time Understaffing/overcrowding
- Patient needs take priority Low risk of acquiring infection from patients
Specific Indications for Hand Hygiene
- Before
– Patient contact
– Donning gloves when inserting a CVC
– Inserting urinary catheters, peripheral vascular catheters, or other invasive devices that don’t require surgery
Specific Indications for Hand Hygiene
- After
– Contact with a patient’s skin
– Contact with body fluids or excretions, nonintact skin, wound dressings
– Removing gloves
Selection of Hand Hygiene Agents: Factors to Consider
- Efficacy of antiseptic agent
- Acceptance of product by healthcare personnel
– Characteristics of product
– Skin irritation and dryness
- Accessibility of product
- Dispenser systems
Time Spent Cleansing Hands: One nurse per 8 hour shift
- Hand washing with soap and water: 56 minutes
– Based on seven (60 second) handwashing episodes per hour
- Alcohol-based handrub: 18 minutes
– Based on seven (20 second) handrub episodes per hour
~ Alcohol-based handrubs reduce time needed for hand disinfection
Surgical Hand Hygiene/Antisepsis
- Use either an antimicrobial soap or alcohol-based handrub
- Antimicrobial soap: scrub hands and forearms for length of time recommended by manufacturer
- Alcohol-based handrub: follow manufacturer’s recommendations. Before applying, pre-wash hands and forearms with non-antimicrobial soap