Infection Control Nur 120 Fall 20141 Final

8/10/2019 Infection Control Nur 120 Fall 20141 Final

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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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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.


7/387Copyright 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.

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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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 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.


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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Infection Control Nur 120 Fall 20141 Final

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