infection control nur 120 fall 20141 final
TRANSCRIPT
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1Copyright 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
BALTIMORE CITY COMMUNITY COLLEGE
DEPARTMENT OF NURSING
INTRODUCTION TO NURSING PRACTICE
Prof. Maria Robinson, RN, MS
Fall 2014
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INFECTION CONTROL & PREVENTION
Healthcare-associated infections (HAI) - infections that people
acquire while they are receiving treatment for another condition in ahealth care setting.
Acquired anywhere health care is delivered
A. Inpatient acute care hospitalsB. Outpatient settings
C. Long-term care facilities
Caused by pathogens, bacteria, fungi, viruses
and other less common protozoa
Significant cause of morbidity and mortality.
Cost the U.S. health care system billions of dollars each year
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3Copyright 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
INFECTION CONTROL & PREVENTION
Asepsis is the absence of contamination by disease-
causing microorganisms; it is essential to prevent HAI
reduce the transmission of infection, and to protect
patients and healthcare workers from infection.
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NATURE OF INFECTION
Infection - invasion of a susceptible host by a
pathogen
Colonizationpresence and growth of a
microorganism within a host but without tissueinvasion or damage
Communicable diseaseinfection transmitted
directly from one person to another
Symptomaticpathogen multiple cause
sign/symptoms
Asymptomatic clinical sign and symptoms are not
present
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CHAIN OF INFECTION
The process by which infections spread is called the
chain of infection. Made up of six links, all of which must be present for
infection to be spread from one individual to another.
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CHAIN OF INFECTION
Infectious agent or pathogen - bacteria, viruses, fungiSome microorganisms live on or in the body without causing harm.
Normal floramay become pathogenic if disease or injury permit
them to enter body regions they dont normally live
Reservoira place where pathogens survive and multiply
Animals, insects, and humans are living reservoirs of
infection. Soil, water, food, surfaces can be nonliving
reservoirs.
carriers,have no symptoms of disease, but can transmit
disease to others.
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CHAIN OF INFECTION
Portal of exitpoint of escape for the organism - the mostfrequent portal of exit is through body fluids, including blood,
mucus, saliva, breast milk, urine, feces, vomitus, semen, or other
secretions.
Modes of Transmission- Contact, either direct or direct, is the
most frequent mode of transmission of infection,
A vector is an organism that carries a pathogen to a susceptible host,
either by biting or by carrying the pathogen on its body. A common
vector for diseases, including malaria, yellow fever, is the mosquito.
Portal of Entry- Pathogens enter the body through a number of
portals of entry. conjunctiva of the eye, nares, mouth, urethra,
vagina, and anus are potential portals of entry, cuts and scrapes.
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CHAIN OF INFECTION
Indirect contact involves contact with a fomite
(a contaminated object that transfers a pathogen). For example,
suppose that while you are charting you begin to sneeze and
cough, if you cover your nose and mouth with your hand and then
resume charting, you may transmit pathogens to the pen, paper,and chart. Eyeglasses, stethoscopes, and other items we wear
also commonly serve as fomites, as do contaminated needles.
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9Copyright 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
Question
Which of the following is the most significant and
commonly found infection-causing agent in
healthcare institutions?
A. BacteriaB. Fungi
C. Viruses
D. Mold
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Answer
Answer: A. Bacteria
Rationale:
Bacteria are the most significant infection-causing
agents in the healthcare system. Bacteria can becategorized by shape, by their reaction to the
Gram stain, or according to their need for oxygen.
Fungi (molds and yeasts) can cause infection and
are present in the air, soil, and water.Viruses cause infections including the common
cold and do not respond to antibiotics.
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INFECTIONS CLASSIFIED BY LOCATION
AND DURATION
Local infectionsharm in a limited region of the body, such as theupper respiratory tract, the urethra, or a single bone or joint
Systemic infections occur when pathogens invade the blood or
lymph and spread throughout the body.
Bacteremia is the clinical presence of bacteria in the blood.
Septicemia is symptomatic systemic infection spread via the
blood.
A primary infection is the first infection that occurs in a patient.
Following a primary infection, especially in an
immunocompromised patients, may be one or more secondaryinfections
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HEALTHCARE-ASSOCIATED INFECTIONS (HAI)
HAI may be exogenous infections pathogen acquired from thehealthcare environment or endogenous infections pathogen arises
from patients normal flora, and some form of treatment
chemotherapy or antibiotics causing normally harmless microbes to
multiply and cause infection
Iatrogenic infections develop from a therapeutic procedure - foley
catheter
Acute infections have a rapid onset but last only a short time
Chronic infections that develop slowly and last for weeks, months,
years - (HIV).
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STAGES OF INFECTION
Incubation Period- the stage between successful invasion of the
pathogen into the body and the first appearance of symptoms.The person does not suspect that he has been infected but may be
capable of infecting others. last only 1 day - influenza virus, or as
long as several months or even years.
Prodromal Stage- appearance of vague symptoms - Malaise, low-
grade fever, fatigue - person with herpes has itching and tingling
at site before actual lesions appear.
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STAGES OF INFECTION
Illness Stagestage marked by the appearance of signs &
symptoms characteristic of the disease. strep throat is
characterized by sore throat, pain, and swelling. If the
patients immune defenses and medical treatments are
ineffective, this stage can end in the death of the patient.
Convalescence- characterized by tissue repair and a return
to health as the remaining number of microorganisms
approaches zero.Convalescence may require only a day or two, or for severe
infections, as long as a year or more
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BODYS DEFENSES AGAINST INFECTION?
The body has three lines of defense against infectious disease.
First, certain anatomical features limit the entry of pathogens.
Second, protective biochemical processes fight pathogens that do
enter.
Third, the presence of pathogens activates immune responses
against specific, recognized invaders.
The first two lines of defense are nonspecific; that means they have
no means of adapting their responses to each specific invader.
Instead, they act in precisely the same way against any and all
intruders, from a simple cold virus to deadly fungal spores.
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IMMUNE RESPONSES
Antigen: foreign particles or substances(i.e. virus or bacteria) that invades/enters the host
foreign invader
Antibody: formed in response to the antigen (virus or
bacteria). Protection produced by the body to protect
it from the foreign invader.
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BODY SYSTEM DEFENSES
(SPECIFIC RESPONSE) ACQUIRED IMMUNITY
Active immunityOccurs when antigen enters the body and body
responds by producing antibody. Body takes an
active role in making the antibody.
Natural (infection) or artificial (vaccine).
- Natural
- Artificial
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BODY SYSTEM DEFENSES
(SPECIFIC RESPONSE) ACQUIRED IMMUNITY
Passive immunity
Acquired immunity resulting from antibodies
transferred from another human or animal.
Immediate short-term protection.- Natural
- Artificial
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Cas
PROMOTING HOST DEFENSES
e Study (contd) Hygiene- Hygiene is crucial in maintaining skinintegrity. Intact skin is one of the best defenses
against infection. Frequent hand washing, as well
as regular showering or bathing, decreases thebacterial count on the skin.
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Infection Prevention and Control
Rest and ExerciseBoth rest and exercise are necessary to
rejuvenate the body.
Stress ReductionStress, whether physical or mental,
decreases the bodys immune defenses. Studies show
correlations between increased stress and increased disease.
Laughing, in contrast, increases oxygenation, promotes body
movement, and increases immune responses.
ImmunizationsImmunization via vaccination can protect
against several infectious disease. Immunizations expose the
body to weakened or killed pathogens, stimulating an
immune response
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NURSING ASSESSMENT
)
Ask the client about any exposure to pathogens in the
environment
Any unusual foods or products ingested
Past and present disease or injury history Medications, OTC preparations, herbal products, alcohol
intake, and any substances currently in use
Current level of stress
Immunization history Symptoms of illness
Observe general appearance
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Question
Which one of the following infections or diseases
may be spread by touching a contaminated
inanimate article?
A. RabiesB. Giardia
C.E. coli
D. Influenza
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Answer
Answer: D. Influenza
Rationale:
Influenza may be spread if a person touches a
contaminated article and then touches his eyes ornose.
The reservoir for rabies is animals; for Giardia,
water; and forE. coli, water or food.
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Question
Tell whether the following statement is true or false.
Standard precautions should be used when caring
for a noninfectious, postoperative patient who is
vomiting blood.A. True
B. False
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Answer
Answer: A. True
Standard precautions should be used when caring
for a noninfectious, postoperative patient who is
vomiting blood.
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Common Tests for Evaluating Presence of Risk
for Infection:
WBC count with differential- A breakdown of the types of WBCs;
normally WBC count is 5,000-10,000/cu mm
Blood cultures- a sample of blood placed on culture media and
evaluated for growth of pathogens.
Disease titers- blood tests for specific disease immunity
Panels to evaluate specific disease exposure- blood test to evaluateexposure to specific diseases (i.e., HIV, hepatitis)
Immunoglobulin (IgG,IgM) levels- blood test to evaluate humoral
immunity status
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Infection Prevention and Control
NURSING DIAGNOSIS
Risk for Infection r/t altered immune response secondary to
corticosteroid therapy
Risk for Infection r/t impaired skin integrity and poor nutritional
status.
PLANNING OUTCOMES/EVALUATION
Patient will show no signs of localized infection at the infusion
site, as evidenced by the absence of swelling, redness, excessivewarmth, pain, or drainage.
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INTERVENTIONS/IMPLEMENTATION
Reduce exposure to pathogens through the use of
aseptic technique
Maintain skin integrity and natural defenses
against infection Reduce stress
Promote immune function through collaborative
care.
M di l A i
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Medical Asepsis
A state of cleanliness that decreases the potential for the
spread of infections.
Disinfection removes pathogens by physical or chemical
means not all pathogens are eliminated
Sterilization elimination of all microorganisms in or on
an object.
The most important aspect of medical asepsis is handcleanliness.
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Droplet precautions
Pathogen can be spread via moist droplets - sneezing,
coughing, talking. Droplets can spread infection by
direct contact with mucous membranes or indirect
contact Droplet precautions include the following:
Follow all standard precautions.
Follow all contact precautions.
Wear a mask and eye protectionwhen working within 3 feet of
the patient.
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Airborne precautions
The spread of infections that are transmitted on airTB, varicella (chickenpox), severe acute
respiratory syndrome (SARS), and rubeola
(measles). Pathogens that are spread by this
method are very small and can be easilytransmitted through ventilating systems
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Airborne precautions
Follow all standard precautions.
Follow all contact precautions.
Place the patient in a private room or in a room
with a patient with an infection caused by thesame organism and no other infections. Make
sure the room has negative air pressure and that
the air is discharged through a filtration system.
Wear a special mask (N95) if the patient issuspected of having pulmonary TB.
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Protective Environment/Protective
Isolation Patients at high risk for infection are placed in a special form of
isolation . This type of isolation may be used for clients with low
WBCs or clients undergoing chemotherapy.
Follow all standard precautions.
Healthcare workers caring for patients in protective isolation
should not be also providing care for other patients with active
infections.
When patients in protective isolation need to leave the room, they
should wear a mask and have minimal contact with others.
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Protective Environment/Protective
Isolation All persons entering the patients room should wear a
mask and wash their hands with soap and water.
After hand washing, caregivers and visitors should put on
a clean or sterile gown over clothing and take care tokeep the outside of the gown from any contact with
surfaces outside the room.
Once the gown is placed, don gloves.
If the mask or gown becomes wet while you providecare, change it.
Once exiting the room, remove gloves, gown and mask
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Surgical Asepsis
Sterile means without life. it contains no life and
therefore no infectious organisms. surgical
equipment, gauze dressings, or wound irrigation fluid
may be sterile.
Surgical asepsis requires creation of a sterile
environment and use of sterile equipment
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Surgical Asepsis
high heat. Surgical equipment and implanted devices
must be sterilized.
To create a sterile area, personnel perform extensive
cleaning using special solutions and procedures.
A surgical scrub is an extended scrub of the hands
using brush, nail cleaner, and a bactericidal scrubbingagent.
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