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Week 1: Infection Control

Tuesday, September 09, 2014


10:27 PM

Nature of infection
o Pathogens: entry and multiplication of infectious agents in a host
o Communicable or contagious: when an infection is transmitted from one person to
another
Course of infection
o Incubation period
Interval between the entry of pathogen and the appearance of first symptoms
o Prodromal stage
Interval from onset of nonspecific signs and symptoms to more specific signs and
symptoms
"Fuzzy idea of what is going on"
o Illness stage
Interval where client manifests signs and symptoms specific to type of infection
o Convalescence
Interval when acute symptoms of infection disappear
Chain of infection
o Infectious agent (pathogenic microorganism)
Number
Virulence (how strong)
Entry and survival in host
Susceptibility of host (elderly and babies at larger risk)
o Reservoir
Place where the pathogen lives
Food
Oxygen
Water temperature (~95 degrees F)
pH (5-8)
Lighting (dark)
Skin and mucous membranes
Carriers: humans/animals containing pathogens but exhibit no symptoms
In the human body
Respiratory tract
Urinary tract
Gastrointestinal tract
Reproductive tract
Nervous system
Blood
o Portal of exit
Points of escape for the organism
o Mode of transmission
Contact
Direct - person to person
Indirect - contaminated inanimate object (ex. Doorknob)

Droplet - sneezing, coughing, talking

Air

Droplet
Dust particles
Carry microorganisms
Vehicle
Contaminated items
Water
Blood
Food
Vectors
External mechanical transfer
Flies
Mosquitoes
Fleas
Ticks
Birds
o Port of entry
Way to enter new host
Usually the same route as the portal of exit
o Susceptible host
Infectious process
o Severity of disease
Extent of infection - how bad is the infection?
Low extent: pimple
Pathogenicity of microorganisms - virulence
High pathogenicity tends to cause a lot of pain
Susceptible host
*Presence of a pathogen does not mean an infection has to occur (low virulence,
carrier, low number)
*Each link of chain MUST be present in order for infection to occur
o Type of infection
Systemic
Wide spread
Signs
Fever
Increased pulse and respiratory rate
Malaise (not happy)
Anorexia, nausea, vomiting
Enlarged lymph nodes
Localized
In one system or area of the body
Signs
Redness
Edema
Pain and tenderness
Presence of exudates
Warmth of the area upon palpation

Loss of use of the affected area


Laboratory findings when infectious agent present
o Leukocytosis (WBC > 10,000/microliter)
o Elevated erythrocyte sedimentation rate (ESR)
Males: 0-15mm/hr
Females: 0-20mm/hr
o Presence of microorganisms on culture of the specific fluid/area
Defenses against infection
o Normal body flora
o Body system defenses
Skin
Tearing, blinking
Voiding - clears urinary system
Sneezing
o Inflammatory response
Protective reaction that neutralizes pathogens and repairs body cells
o Vascular and cellular response
Acute inflammation delivering WBCs to affected area
o Formation of exudate (fluid)
Serous - yellowish
Sanguineous - Bloody
Purulent - pus-like, yellowish
o Tissue repair
Community acquired infections
o Acquired in community
o MRSA is out in the community and commonly found in the gym
Nosocomial infections
o Result from delivery of health services in a healthcare setting, clients are at increased
risk
o UTIs are the most common
o Harder to treat
More resistant from antibiotic exposure
o More expensive to treat
Hospitals are not reimbursed for nosocomial infections
Increased hospital stays for patients
o Types
Iatrogenic: from diagnostic or therapeutic procedure (ex. Catheter insertion)
Exogenous: external to individual that do not exist in normal flora (Foreign)
Endogenous: Normal flora that become altered and over-growth occurs (ex. Yeast
infection)
o Clients at increased risk
Lower resistance due to illness or disease
Exposure to an increased number or pathogens
Including super bugs
Performance of invasive procedures (anything that crosses protective barriers)
o Superbugs
MRSA
Methicillin resistant staphylococcus aureus

VRE

Clostridium difficile
Most common cause of nosocomial diarrhea
Causes
Severe diarrhea
Pseudomembranous colitis
Toxic megacolon
Intestinal perforation
Transmission: fecal-oral route
Overgrowth in intestines from antimicrobial use
Hands of healthcare worker
Environmental contamination
Detection: stool enzyme immunoassay (EIA)
Hand hygiene: spores must be removed through mechanical action; hand
washing

CRE

Vancomycin resistant enterococcus


Normally found in bowel and female genital tract
Live in environment up to 7 days on hands, gloves, equipment, bed rails,
stethoscopes, etc.
Cross-infection attributed to thermometers, commodes, uncleansed
furniture
Transmitted directly (via hands of health care worker) or indirectly (via
contact with contaminated item)

C. diff

Common in hospitals and long term care facilities


Easily transmitted by healthcare workers and frequently colonizes on skin
Resistant to almost all antibiotics
High mortality rate
Important to wash hands

Carbapenem-resistant Enterobacteriaceae
Strikes immune-compromised patients
People who are hospitalized for a long time
People who are living in a long term care facility
Symptoms
Nausea
Dizziness
Fever, chills
Pneumonia
Urinary tract infection
Diarrhea with cramping
No drugs to treat it

Assessment
o Status of body defenses
o Client susceptibility
o Age
o Nutritional status
o Stress

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Disease process - what is known about it


Medical therapy - treatment
Clinical appearance
Laboratory data
Clients with infections - protect self and patient
Nursing interventions: Infection control
o Aseptic technique
Hand washing
Proper personal protective equipment (PPE)
Gowning and gloving
Wearing facial masks
Caps
Goggles
Booties
o Immunizations - children, older adults, people with chronic diseases or
immunocompromised
o Good oral hygiene - decreases growth of microorganisms that can migrate through
breaks in the oral mucosa
o Consume adequate fluids - flushes urinary tract and keeps skin from breaking down
o Promote pulmonary hygiene in immobile clients
o Separating clean from contaminated materials
*Frequent hand washing dries skin, leading to it breaking down and cracking; use hand
moisturizer to protect self from breaking the skin barrier and being potentially exposed
to infections
o Tier One Standard Precautions
Applies to all body fluids (except sweat), non-intact skin, or mucous membranes
Help control contamination with blood borne viruses (HIV, Hepatitis B)
Wear gloves, gown, mask, goggles
Implementation
Equipment is cleaned or disposed of properly, including sharps
Private room is unnecessary unless client's hygiene is unacceptable
Client and family education
Psychosocial effects
Physical protection gained from barrier isolation may have negative
psychological impact on patient
Patient feels dirty
Feelings of loneliness and isolation
Interferes with providing emotional support
o Tier two Transmission Precautions
Protective precautions for specific modes of transmission
Airborne (varicella, measles, TB)
Droplets larger than 5 micrometers (pneumonia, scarlet fever, rubella,
pertussis, sepsis)
Contact (varicella zoster, RSV, scabies)
Protective environment
Isolation/Protective environments: private rooms used for isolation, some
with negative pressure airflow to prevent microorganisms from flowing out
of the room

Personal hygiene
o Restrain hair - hair falling forward may drop organisms
o Keep nails short - no acrylic nails or chipped nail polish
o Minimum jewelry
o Cover open wounds with an occlusive dressing (sealed on all sides)
Basic infection control
o Implementation
Microorganisms move through space on air currents (avoid shaking or tossing
linen)
Microorganisms are transferred from one surface to another whenever they
tough
Keep hands away from face
Keep linens away from uniforms
An item dropped on the floor is considered dirty
Microorganisms are transferred by gravity when one item is held above another
Avoid passing dirty items over clean items
Clean items on upper shelves, dirty items on lower shelves (ex. Bedpan)
Microorganisms are released into the air on droplet nuclei whenever a person
breathes/speaks
Avoid breathing in someone's face
Cover mouth and nose
Wash hands
Microorganisms move slowly on dry surfaces and quickly through moisture
Use dry paper towel to turn off faucet
Proper hand washing removes many microorganisms that would be transferred
to other items or people
Hand washing
Most important procedure for preventing the spread of microorganisms or
infections
CDC recommends 10 - 15 seconds of hand washing
Alcohol gels kill most microorganisms including good ones
Indications for hand washing
When visibly dirty
Before and after client contact
After contact with a source of microorganisms (blood, body fluids,
mucus membranes, non-intact skin, or inanimate objects that might
be contaminated)
Prior to performing invasive procedures (IV catheters, indwelling
catheters)
Before applying gloves
After removing gloves
At the beginning and end of each shift
Antiseptics (used on skin) and disinfectants (used on inanimate objects)
Antiseptics are antimicrobial substances used on living tissue or skin
to reduce the possibility of infection or sepsis
Disinfects are applied to non-lining objects to destroy
microorganisms
Ideal antiseptic

Safe
Effective
Selective
Germicidal
Broad spectrum of antimicrobial activity
For routine hand antisepsis, alcohol-based hand rubs are
preferred to soap and water
Guidelines for specific institutions
Methods of infection control standardized by
CDC
OSHA
Standards are applied in all healthcare facilities
Healthcare workers must practice within guidelines