Professional Documents
Culture Documents
Chain of Infection
The incubation period is the time between entrance of the pathogen and the first
symptoms. If the host's defenses are successful, an infection may disappear
without progressing to the next stage.
Examples of incubation periods for specific diseases:
Mumps: 18 days
Varicella (chickenpox): 2 to 3 weeks
Prodromal Stage
Not all diseases have prodromal periods. For those that do, the prodromal
stage is the time from onset of nonspecific findings, such as fatigue and
malaise, to disease-specific findings. This is when the pathogen is multiplying
and the host is most contagious.
Invasive Phase
During the invasive phase, the person exhibits the specific findings of the disease:
If the host cannot fight off an infection, such as pneumonia, influenza or a urinary
tract infection (UTI), the invasive phase can progress to systemic complications
such as septicemia and even death. Other diseases, such as varicella (chickenpox)
virus can reactivate years later, causing shingles.
Many of the preventable childhood diseases can cause (irreversible) complications:
Convalescence
Convalescence is when the acute findings begin to disappear and the body returns
to normal health.
The most common healthcare-associated infection (HAI) is usually caused by a "staff" infection -
one that is transmitted from a health care worker, or "staff," to a client.
Infection Control
Hand hygiene is the foundation of all infection control practices in health settings.
The following information provides an overview of the various processes used to
reduce or eliminate infections.
Medical Asepsis
Hand hygiene — the single most effective and important way to prevent the spread
of microorganisms:
o Friction — loosens the microorganisms so they can be removed
o Soap – non-antimicrobial soap and water or with antimicrobial soap and water if
contact with spores, including Clostridium difficile or Bacillus anthracis
Disinfectants and antiseptics:
o Disinfectant: a substance that reduces the number of microorganisms, including
bleach solutions and Zephirin (or other quaternary ammonium compounds)
o Antiseptic: a substance that can be applied to skin to reduce the number of
microorganisms, including alcohol, povodine iodine solutions (such as Betadine®)
and 2% chlorhexadine solution such as (ChloraPrep®)
Practices that interrupt transmission, such as the use of personal protective
equipment
Surgical Asepsis
Surgical asepsis includes the practices that destroy all microorganisms and their
spores, such as steam under pressure, gas, radiation and chemicals. Some very
basic guidelines of surgical asepsis include:
Standard Precautions
Wash hands with soap and water when visibly dirty or contaminated.
Wash hands or use an antiseptic handrub:
o Immediately when there is direct contact with blood, body fluids, secretions,
excretions or contaminated items
o After contact with a person's intact skin, such as when taking a pulse or blood
pressure, or moving or repositioning a client
o After contact with inanimate objects, including medical equipment in the immediate
vicinity of the client
o After removing gloves
o Between client contact
Wear gloves before touching anything wet or before performing invasive procedures
Use masks, goggles, face masks and other personal protective equipment (PPE) to
protect mucous membranes of the eyes, nose and mouth when contact with blood
and body fluids is likely
Transmission-based Precautions
Contact Precautions
You should wear a gown and gloves for all interactions that may involve contact
with the client or potentially contaminated areas in the client's environment.
With Clostridium difficile (C. diff) infections, you must wash your hands with soap and water
because alcohol-based hand sanitizer does not kill the spores.
Droplet Precautions
Respiratory droplets are generated when an infected person coughs, sneezes, talks
or during procedures such as suctioning, endotracheal intubation, cough induction
by chest physiotherapy and cardiopulmonary resuscitation. Transmission of these
large particle droplets occurs when they come in contact with the conjunctivae or
the mucous membranes of the nose or mouth of a susceptible person.
When close contact (typically within three feet or less) between the source client
and a susceptible person is required, you should use a standard surgical mask.
Airborne Precautions
Airborne precautions are used when microorganisms dispersed through the air over
long distances remain infective over time and distance.
To prevent the spread of airborne pathogens, the client should be placed in a room
with special airflow and ventilation systems (airborne infection isolation room or
AIIR) and nurses should use respiratory protection with a NIOSH-certified N95 or
higher level respirator when in the room.
Neutropenic Precautions
Neutropenic precautions are used to prevent infection in clients who have
neutropenia (low white blood cell counts) or are immunocompromised.
Protecting Nurses
Injury is one of the hazards of direct nursing care. The physical demands of moving
and repositioning clients can result in musculoskeletal injuries, especially back
injuries. Needlestick injuries expose nurses to infection. Exposure to occupational
chemicals and the potential for violence also have severe consequences for a
nurse's health.
The client's level of dependence, such as whether the client can bear weight or
has upper body strength.
Whether the client is alert, oriented and cooperative.
Based on your assessment and documented information, you will also need to
determine the amount of assistance needed and the type of equipment needed.
Since manual lifting is unsafe for clients and caregivers, mechanical equipment such
as ceiling- or Hoyer-type lifts should be used. You will need to know how the
equipment works and match it to the needs of the client and limitations of the
room/area before you move the client.
Repositioning a client in bed is never a one person task. If possible, the bed should
be flat, the height of the bed appropriate for staff safety (at the elbows). If
possible, the client should flex the knees and push on the count of three; otherwise,
you should use a slider board. You should take great care to reduce friction and
shearing when moving a client in bed.
Needlesticks
If you are stuck by a needle or other sharp object or get blood or other potentially
infectious materials in your eyes, nose, mouth, or on broken skin, you should
immediately flood the exposed area with water and then clean any wound with soap
and water or available skin disinfectant. You will then report the incident to your
employer and seek further medical attention.
Workplace Violence
Nurses and UAP are increasingly experiencing verbal or physical abuse – such as
yelling, cursing, grabbing, scratching or kicking - from clients and visitors. Nurses
are more vulnerable to violence since they are the ones who most frequently
interact with clients and their families.
Many nurses consider violence by clients as part of the job and that some clients
cannot be held accountable for their violent actions, which is why many incidents of
violence go unreported. However, nurses must report incidents of violence.
Moreover, clients and visitors must be held accountable for their behavior. In fact,
many states have enacted enforceable legislation that make it a felony to assault or
batter nurses.
Incident Reports
Medication administration errors are one of the most common types of errors made
by nurses. When you realize that you made an error, the first action should be to
report the error to the first person in the chain of command (usually the charge
nurse); the prescriber must also be contacted and orders implemented. After caring
for the patient, you will need to complete an incident (or occurrence) report.
By reporting errors, you are helping to improve processes or create new processes
to minimize errors and risk of harm to patients.
When to Complete an Incident Report
General Guidelines
All organizations have specific guidelines for completing the report, you should
always remember to stick to the facts and report the following information:
Date, time, and exact location of the occurrence (if the specific details are not
known, document the date and time the error was discovered)
Names of persons involved in the incident and any witnesses
Direct quotes from the persons involved in the incident
Objective information describing the incident
Who was notified about the error
Orders received
If indicated, corrective actions taken
The incident report is not part of the patient's medical record and, in most cases, is protected
from discovery during a legal investigation.
Security Plans
A written security plan is designed to protect clients, visitors and staff. The plan
identifies security threats in all areas of a health care facility that could have an
adverse impact on persons and property.
Emergency Department
Examples of security in the emergency department (ED):
Mother-baby Unit
There are multiple tools and devices used to protect against infant abduction in the
mother-baby unit:
Emergency Preparedness
Explosions
Explosions or blasts can cause unique patterns of injury. Most injuries involve
multiple penetrating injuries and blunt trauma. All bomb events have the potential
for chemical and/or radiological contamination.
Treatment overview:
Lung injuries
o High flow oxygen sufficient to prevent hypoxemia via non-rebreather mask, CPAP
or ET tube
o Ensure tissue perfusion but avoid volume overload
o Prompt decompression for clinical evidence of pneumothorax or hemothorax
Abdominal injury - clinical signs can be subtle at first; observe for acute abdomen
or sepsis
Ear injuries may include tinnitus or deafness
Crush injuries - sudden release of a crushed extremity may result in reperfusion
syndrome (acute hypovolemia, renal failure, metabolic abnormalities)
o IV fluid replacement (up to 1.5 L/hour)
o To help prevent renal failure - mannitol to maintain diuresis at least 300
mL/hour; dialysis may be needed
o To treat acidosis - IV sodium bicarbonate until urine pH reaches 6.5 (to prevent
myoglobin and uric acid deposition in the kidneys)
o To treat hyperkalemia/hypocalcemia - calcium gluconate 10% 10 mL or calcium
chloride 10% 5 mL IV over two minutes; sodium bicarbonate 1 mEq/kg IV push
(slowly); regular insulin 5-10 units and D5O 1-2 ampules IV bolus; kayexalate
25-50 g with sorbitol 20% 100 mL PO or PR
Monitor injured areas for the five Ps: pain, paresthesia, paralysis, pulse and pallor
Monitor for sepsis
Injuries resulting in non-intact skin or mucous membrane exposure - hepatitis B
immunization (within seven days) and tetanus toxoid vaccine
Clustered under this category are earthquakes, extreme heat, floods, hurricanes,
tornadoes, tsunamis, volcanoes, wildfires, landslides/mudslides and winter weather.
Mild radiation sickness (absorbed dose of 1-2 Gy): nausea and vomiting,
headache, fatigue, weakness within 24 to 48 hours after exposure
Very severe radiation sickness (absorbed dose of 3.5-5.5 Gy): nausea and
vomiting less than 30 minutes after exposure to radiation, dizziness,
disorientation, hypotension; usually fatal
Treatment overview:
Decontamination:
o Remove clothing and shoes
o Gently wash victim with soap and water
For damaged bone marrow:
o Filgrastim (Neupogen): a protein-based medication which promotes the growth of
white blood cells
o Pegfilgrastim (Neulasta): also increases white blood cells and prevents
subsequent infections
For internal contamination (chelating agents):
o Potassium iodide (KI): used to prevent absorption of radioiodine in the thyroid
gland
o Prussian blue: a type of dye that binds to particles of radioactive elements
(cesium and thallium)
o Diethylenetriaminepentaacetic acid (DTPA): binds to particles of the radioactive
elements plutonium, americium and curium
Supportive treatment for infections, headache, fever, diarrhea and dehydration;
also end-of-life care
Disease Outbreaks
The more common foodborne outbreaks include Salmonella, Listeria and E. coli.
Other recent outbreaks include Ebola virus disease, Avian influenza, Middle East
respiratory syndrome coronavirus (MERS-CoV), H1N1 and Zika virus.
Category A
Category B
Second highest priority agents, mostly due to lower morbidity and mortality rates:
Category C
Nipah virus
Hantavirus
Regardless of the triage system used, the primary goal is to quickly sort victims
into categories and identify each of them, using a tag, tape or some other means.
Triage is intended to do the greatest good for the greatest amount of people. A
common triage system for a mass casualty event is the START triage system. This
system uses a red, yellow, green, black tag system.
Community Setting
victims are categorized based on the severity of the injury, the urgency of needed
treatment and an available place for treatment:
Treated first: individuals who have life-threatening injuries that are readily
correctable.
Treated last:
o Individuals who have no injuries (noncritical injuries) and who are ambulatory.
o Individuals who are dying or are dead.
Health Care Settings
Triage in the emergency department usually involves dividing those who need care
into one of the following three categories: