Unit 8 Content

Front 1

chain of infection

Back 1

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

Front 2

An infection will occur if the chain remains intact

Back 2

Nurses follow infection prevention and control practices to break the chain so that an infection will not develop

Front 3

Breaking the Chain of Infection:

Back 3

•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

Front 4

Breaking the Chain of Infection:

Back 4

• 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

Front 5

Breaking the Chain of Infection:

Back 5

•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

Front 6

Inflammatory response:

Back 6

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

Front 7

Inflammatory response is Triggered by:

Back 7

1)Physical agents
2)Chemical agents
3)Microorganisms
4)Mechanical trauma
5)Temperature extremes
6)Radiation

Front 8

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

Back 8

This process neutralizes and eliminates pathogens or dead tissue and establishes a means of repairing body cells and tissues

Front 9

Local symptoms of inflammation and infection:

Back 9

- Swelling (edema)
- Heat
- Altered Function
- Redness (erythema)
- Pain or Tenderness

Front 10

Systemic symptoms of inflammation and infection:

Back 10

- Fever
- Leukocytosis
- Malaise
- Anorexia
- Nausea/Vomiting
- Lymph node enlargement

Front 11

Body’s normal defenses against infection
- Primary

Back 11

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

Front 12

Body’s normal defenses against infection
- Secondary

Back 12

1) inflammatory response
2)Immune response

Front 13

What happens when normal flora is lost?

Back 13

- Antibiotics are not always the answer
- Suprainfection

Front 14

Body System Defenses against infection:

Back 14

- Skin
- Mouth
- Respiratory tract
- Urinary tract
- Gastrointestinal tract
- Vagina

Front 15

Not all inflammation is an infection, but

Back 15

all infection has inflammation!!

Front 16

Immune Response:

Back 16

- Triggered in response to invading microorganism
- Antigen- Foreign material, not normally found in a person’s body that causes an immune response

Front 17

4 Stages of Infection

Back 17

1. Incubation period
2. Prodromal stage
3. Illness stage
4. Convalescence

Front 18

Factors that increase an individual’s risk for infection:

Back 18

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

Front 19

Conditions that promote the transmission of nosocomial infection:

Back 19

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

Front 20

MRSA

Back 20

- 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

Front 21

VRE

Back 21

- 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

Front 22

Risk factors for VRE

Back 22

- 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

Front 23

Clostridium Difficile

Back 23

- A bacterium that causes diarrhea and more serious intestinal conditions such as colitis.

Front 24

Risk factors for C. Diff

Back 24

- Patients requiring prolonged use of antibiotics
- Prolonged Hospitalization
- Elderly

Front 25

Preventing Antimicrobial Resistance

Back 25

- 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

Front 26

2 components of the Immune system:

Back 26

1. Cell-mediated defenses
2. Antibody-mediated defenses (Humoral)

Front 27

Cell-mediated defenses

Back 27

- 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

Front 28

Antibody-mediated defenses (HUMORAL)

Back 28

- 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

Front 29

2 types of Acquired Immunity

Back 29

1. Active acquired immunity
2. Passive acquired immunity

Front 30

Active Acquired Immunity

Back 30

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

Front 31

Passive Acquired Immunity

Back 31

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

Front 32

Natural (non-acquired) Immunity

Back 32

- (aka:Genetic)
- Programmed in the DNA
- Ex: Why dogs don’t get measles

Front 33

Examples for breaking the chain of infection:

Back 33

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

Front 34

WBC count with differential

Back 34

normal WBC values: 5000-10,000/mm (5-10)

Front 35

Neutrophils

Back 35

55%-70%

Front 36

Lymphocytes

Back 36

20%-40%

Front 37

Monocytes

Back 37

2%-8%

Front 38

Eosinophils

Back 38

1%-4%

Front 39

Basophils

Back 39

0.5%-1%

Front 40

culture and sensitivity

Back 40

- is desirable to optimize therapy:
– Urine, blood, stool, sputum, throat, wound drainage

Front 41

Effects inflammation and infection have on values:

Back 41

↑ WBC
↑ ESR- normal: up to 15mm/hr for men 20mm/hr for women
↓ Iron level- normal: 60-90 g/100ml

Front 42

Abnormal WBC findings
↑ WBC (Leukocytosis)

Back 42

- Infection
- Leukemia
- Trauma
- Stress
- Tissue necrosis
- Inflammation

Front 43

Abnormal WBC findings
↓ WBC (Leukopenia)

Back 43

- Drug toxicity
- Bone marrow failure
- Overwhelming infections
- Dietary deficiency
- Autoimmune disease
- Bone marrow infiltration

Front 44

Recommended immunization schedules:

Back 44

• 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

Front 45

Centers for Disease Control and Prevention Isolation Guidelines:

Back 45

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

Front 46

Types of exudate

Back 46

- Serous
- Sanguinous/hemorrhagic
- Purulent
- Fibrinous
- Mucinous/catarrhal

Front 47

Assessing a patient

Back 47

-Status of body defenses
-Susceptibility of the patient
-Stress upon the patient
-Heredity
-Disease process symptoms
-Laboratory tests
-Treatment

Front 48

Patient/family teaching

Back 48

-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

Front 49

Antimicrobial therapy

Back 49

- Antifungal Agents
- Anti-infective Agents (Antibiotics)
- Antiviral Agents
* Prolonged use of antimicrobials may lead to superinfection with fungi or resistant bacteria.*

Front 50

Antifungal agents -STOP GROWTH OR KILL FUNGUS

Back 50

- 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

Front 51

- 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.

Back 51

– 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

Front 52

Antiviral agents- Inhibit viral replication

Back 52

- ACYCLOVIR: Herpes, chickenpox
- FAMCICLOVIR: Herpes
- VALACYLOVIR: Herpes
- ZANAMIVIR: Influenza A viral infections
- CIDOFOVIR, GANCICLOVIR, & FOSCARNET: used for cytomegalovirus retinitis

Front 53

Nursing diagnosis:

Back 53

– Infection: risk for

Front 54

Risk Factors

Back 54

– 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

Front 55

Expected outcomes

Back 55

– 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

Front 56

Interventions

Back 56

– 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

Front 57

Interventions

Back 57

– Assess immunization status
– Maintain and/or teach asepsis
– Wash hands
– Limit visitors
– Encourage protein and calories
– Encourage fluid intake

Front 58

Interventions

Back 58

– 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

Front 59

Interventions

Back 59

- 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

Front 60

Other potential nursing diagnoses:

Back 60

- Knowledge deficit r.t. medication regimen
- Noncompliance r.t. medication regimen
- Skin integrity, Impaired r.t. broken area, serous drainage, inflammation

Front 61

Most common mode of transmission of pathogens is via hands!

Back 61

- Infections acquired in healthcare
- Spread of antimicrobial resistance

Front 62

23. Evidence of Relationship Between Hand Hygiene and Healthcare-Associated Infections

Back 62

- Substantial evidence that hand hygiene reduces the incidence of infections
- Historical study: Semmelweis
- More recent studies: rates lower when antiseptic handwashing was performed

Front 63

Self-Reported Factors for Poor Adherence with Hand Hygiene

Back 63

- 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

Front 64

Specific Indications for Hand Hygiene
- Before

Back 64

– Patient contact
– Donning gloves when inserting a CVC
– Inserting urinary catheters, peripheral vascular catheters, or other invasive devices that don’t require surgery

Front 65

Specific Indications for Hand Hygiene
- After

Back 65

– Contact with a patient’s skin
– Contact with body fluids or excretions, nonintact skin, wound dressings
– Removing gloves

Front 66

Selection of Hand Hygiene Agents: Factors to Consider

Back 66

- Efficacy of antiseptic agent
- Acceptance of product by healthcare personnel
– Characteristics of product
– Skin irritation and dryness
- Accessibility of product
- Dispenser systems

Front 67

Time Spent Cleansing Hands: One nurse per 8 hour shift

Back 67

- 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

Front 68

Surgical Hand Hygiene/Antisepsis

Back 68

- 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