PREVENTING THE

TRANSFER OF
MICROORGANISMS

Ns SUJUD PRIONO, S.Kep

 CHAIN OF INFECTION

1
Etiologic agent
(microorganism)

6 2
Susceptible host Reservoir (source)

5 3
Portal of entry to Portal of exit from
the susceptible host reservoir

4
Method of
transmission
 ETIOLOGIC AGENT

BIOLOGICAL AGENTS
o BACTERIA, VIRUSES, FUNGI, PROTOZOA,
RICKETTSIA

CHEMICAL AGENTS
o PESTICIDES, FOOD ADDITIVES,
MEDICATIONS, INDUSTRIAL CHEMICALS

PHYSICAL AGENTS
o HEAT ,LIGHT, NOISE , RADIATION
 RESERVOIR

HUMANS
RESPIRATORY TRACT, GASTROINTESTINAL TRACT, URINARY
TRACT, REPRODUCTIVE TRACT, BLOOD,TISSUE

 PLANTS

 ANIMALS

INSECTS, BIRDS, CAT, ANOPHELES MOSQUITO

GENERAL ENVIRONMENT
 PORTAL OF EXIT FROM RESERVOAR

 RESPIRATORY TRACT : NOSE / MOUTH (SNEEZING, COUGHING,

BREATHING, TALKING) , TRACHEOSTOMIES

 GASTROINTESTINAL TRACT : MOUTH (SALIVA, VOMITUS) , ANUS,

DRAINAGE TUBES

 URINARY TRACT : URETHRAL MEATUS

 REPRODUCTIVE TRACT : VAGINA, URINARY MEATUS

 BLOOD : OPEN WOUND, NEEDLE PUNCTURE SITE, ANY

DISRUPTION OF INTACT SKIN OR MUCOUS MEMBRANE SURFACE
 METHOD OF TRANSMISSION

DIRECT TRANSMISSION

 TOUCHING, BITTING, KISSING, SEXUAL INTERCOURSE

 DROPLET : SNEEZING, ,COUGHING, TALKING

INDIRECT TRANSMISSION
 VEHICLE BORNE TRANSMISSON : WATER, FOOD, TOYS, SOILED CLOTHES,
COOKING OR EATING UTENSILS, SURGICAL INSTRUMEN
 VECTOR BORNE TRANSMISSION: ANIMAL OR FLAYING OR CRAWLING
INSECT

AIRBORNE TRANSMISSION

 DROPLET NUCLEI
 SUSCEPTIBLE HOST

HOST FACTOR THAT INFLUENCE RISK OF INFECTION

 NATURAL IMMUNITY : CONGENITAL OR ACQUIRED IMMUNODEFICIENCIES

 NORMAL FLORA : ALTERATION OF NORMAL FLORA BY ANTIBIOTIC THERAPY
 AGE : INFANT AND OLDERY CLIENT
 HORMONAL FACTORS : DIABETES, CORTICOSTEROID THERAPY
 PHAGOCYTOSIS : DEFECTIVE PHAGOCYTIC FUNCTION, CIRCULATORY
DISTURBANCES
 SKIN / MUCOUS MEMBRANES / NORMAL EXCRETORY SECRETIONS : BREAK IN
SKIN ; INTERFERENCE WITH FLOW OF URINE, TEARS OR SALIVA ; INTERFERENCE
WITH COUGH REFLEX OR CILIARY ACTION ; CHANGE IN GASTRIC SECRETIONS
 MALNUTRITION
 ENVIROMENTAL FACTORS : SMOKING, ALCOHOL CONSUMPTION, INHALATION
OF TOXIC CHEMICALS
 MEDICAL INTERVENTIONS : INVASIVE THERAPY, CHEMOTHERAPY, SURGERY,
STEROID THERAPY, RADIATION THERAPY
STAGES OF AN INFECTIOUS
PROCESS

INCUBATION PERIOD

PRODROMAL PERIOD

ILLNESS PERIOD

CONVALESCENT PERIOD
 NOSOCOMIAL INFECTION
ADALAH INFEKSI YANG DIDAPAT KLIEN KETIKA DIRAWAT DI
RUMAH SAKIT
KRITERIA :
PADA WAKTU KLIEN MULAI DIRAWAT DI RS TIDAK


DIDAPAT TANDA-TANDA KLINIK DARI INFEKSI TSB

PADA WAKTU KLIEN MULAI DIRAWAT DI RS TIDAK SEDANG


DALAM MASA INKUBASI DARI INFEKSI TSB

TANDA INFEKSI BARU TIMBUL SEKURANG-KURANGNYA


SETELAH 3 X 24 JAM SEJAK MULAI PERAWATAN

INFEKSI TERSEBUT BUKAN MERUPAKAN SISA (RESIDUAL)


DARI INFEKSI SEBELUMNYA

BILA SAAT MULAI DIRAWAT DI RS SUDAH ADA TANDA-


TANDA INFEKSI, DAN TERBUKTIINFEKSI TERSEBUT DIDAPAT

KLIEN KETIKA DIRAWAT DI RS YANG SAMA PD WAKTU
TANG LALU, SERTA BELUM PERNAH DILAPORKAN SEBAGAI
INFEKSI NOSOKOMIAL
 JENIS –JENIS INFEKSI
NOSOKOMIAL

BAKTEREMIA NOSOKOMIAL
INFEKSI NOSOKOMIAL LUKA OPERASI
HEPATITIS VIRUS NOSOKOMIAL
INFEKSI SAL CERNA NOSOKOMIAL
INFEKSI SAL NAFAS NOSOKOMIAL
INFEKSI SAL KEMIH NOSOKOMIAL
 BAKTEREMIA

BATASAN KLINIK
DEMAM YANG MENCAPAI 38,5 C ATAU LEBIH, YANG BERTAHAN
MINIMAL 24 JAM, ATAU YANG BERULANG PALING SEDIKIT 4 KALI
DALAM 24 JAM DENGAN ATAU TANPA PEMBERIAN ANTIPIRETIK. SUHU
BADAN DIUKUR SECARA AKSILAR SELAMA 5 MENIT, DIULANG SETIAP 3
JAM
APABILA KLIEN MENUNJUKKAN GEJALA SEPSIS DENGAN ATAU TANPA
TANDA-TANDA SHOCK, SUHU TUBUH DIUKUR SECARA ORAL ATAU
REKTAL

BATASAN LABORATORIK
 DITEMUKAN KUMAN PADA BIAKAN DARAH
 DITEMUKAN KUMAN PADA BIAKAN UJUNG KATETER PEMB. DARAH
 DEFENSE AGAINST INFECTION
 NON SPECIFIC

 BODY TISSUES
 PHAGOCYTOSIS
 INFLAMATION

 SPECIFIC

 ANTIBODY
 NON SPECIFIC DEFENSE MECHANISM
• INTACT SKIN : PROVIDES A BARRIER, NORMAL FLORA AND
ACID pH

• MUCOUS MEMBRANE : MUCOCILLIARY ACTION CLEARS

BACTERIA, LYSOSOME DISSOLVE BACTERIAL WALL

• RESPIRATORY TRACT : MUCOCILLIARY ACTION , COUGH,

LYSOSOME ACTION, HUMIDIFICATION

• GASTROINTERTINAL TRACT : PERISTALSIS, ENZYMES, ACID pH

NORMAL BOWEL FLORA

• GENITOURINARY TRACT : FLUSHING ACTION OF URINE,

ACID pH
 BODY SUBSTANCE PRECAUTIONS

BODY FLUIDS TO WHICH UNIVERSAL PRECAUTIONS

BLOOD AND OTHER BODY CONTAINING VISIBLE BLOOD

SEMEN AND VAGINAL CERVICAL SECRETIONS
TISSUES
CEREBROSPINAL FLUID
AMNIOTIC FLUID
SYNOVIAL FLUID
PLEURAL FLUID
PERITONEAL FLUID
PERICARDIAL FLUID
BODY FLUIDS TO WHICH UNIVERSAL PRECAUTIONS DO NOT
APPLY UNLESS THEY CONTAINING VISIBLE BLOOD

FECES
NASAL SECRETIONS
SPUTUM
VOMITUS
SWEAT
TEARS
URINE
BREAST MILK
SALIVA, EXEPT IN DENTISTRY
 ASSESSING
• NURSING HISTORY :
 THE DEGREE TO WHICH A CLIENT IS A RISK OF DEVELOPING AN INFECTION
 ANY CLIENT COMPLAINTS SUGGESTING THE PRESENT OF AN INFECTION

• PHYSICAL HEALTH DATA

LOCALIZED INFECTION
 LOCALIZED SWELLING : LOCALIZED SWELLING, LOCALIZED REDNESS, PAIN OR
TENDERNESS WITH PALPATION OR MOVEMENT
 PALPABLE HEAT AT THE INFECTED AREA
 LOSS OF FUNCTION OF THE BODY PART
SYSTEMIC INFECTION : FEVER, INCREASED PULSE AND RR, MALAISE, ANOREXIA, VOMITING,
ENLARGEMENT AND TENDERNESS OF LYMPH NODES

• LABORATORY DATA : ELEVATED LEUKOCYTE, INCREASED IN SPECIFIC TYPED OF

LEUKOCYTE, ELEVETED ERYTHROCYTE SEDIMENTATION RATE, PRESENT
MICROORGANISM IN URINE, BLOOD OR OTHER DRAINAGE CULTURES
 DIAGNOSING
 HIGH RISK FOR INFECTION
 ALTERED ORAL MUCOUS MEMBRANE
 HIGH RISK ALTERED BODY TEMPERATURE
 IMPAIRED SKIN INTEGRITY
 IMPAIRED PHYSICAL MOBILITY
 ALTERED NUTRITIONS
 PAIN
 SOCIAL ISOLATION
 SELF ESTEEM DISTURBANCE
 ANXIETY
 FEAR
 HOPELESSNESS
 BREAKING THE CHAIN OF INFECTION

SUSCEPTIBLE HOST : INTACT IMMUNE SYSTEM, BALANCED

NUTRITION, SKIN INTEGRITY

INFECTIOUS AGENT : CLEANING, DESINFECTION, STERILIZATION

RESERVOIR OF SOURCE: HYGIENE, DRESSING CHAGES, DISPOSAL OF

FLUID CONTAINER, CHANGE SOILED LINEN

PORTAL OF EXIT FROM RESERVOAR OF SOURCE : CLEAN DRESSING

OVER WOUNDS, COVER MOUTH AND NOSE WHEN COUGHING
OR SNEEZING

MODE OF TRANSMISSION - PORTAL OF ENTRY TO HOST : WEAR

GLOVES, MASKS, GOWNS, GOGGLES ; MEDICAL OR SURGICAL
ASEPSIS ; PROPER DISPOSAL OF CONTAMINATED OBJECTS,
HANDWASHING
 PROCEDURES

 CLEANING
 DECONTAMINATION

 DESINFECTIOS

 STERILIZATION

 HANDWASHING AND SURGICAL HANDWASHING

 APPLYING A SURGICAL MASK

 PERVORMING OPEN GLOVING AND REMOVAL OF SOILED

GLOVES
 PERFORMING GOWNING AND CLOSED GLOVING

 ISOLATION