Chapter 25

Care of Patients with Infection

Mrs. Kreisel MSN, RNNU130 Adult Health 1Summer 2011

Definitions

• Pathogen—any microorganism capable of producing disease

• Communicable—infection transmitted from person to person

• Pathogenicity—the ability to cause disease• Virulence—the degree of communicability

Definitions (Cont’d)

• Normal flora—characteristic bacteria of a body location; it often competes with other microorganisms to prevent infections

• Colonization—the microorganism present in tissue but not yet causing symptomatic disease

• Surveillance—the tracking and reporting of infections

Overview of Chain of Infection

• Reservoirs • Pathogens:

• Toxins• Exotoxins: A toxin produced by a

microorganism and excreted into its surrounding tissue. (liquid medium, unstable, light, heat and chemical sensitivity)

• Endotoxins: bacterial toxin confined within the body of the bacterium, freed only when the bacterium is broken down.

• Host Defenses:• Susceptibility

Immunity

• Resistance to infection is usually associated with the presence of antibodies or cells acting on specific microorganisms.

• Passive immunity is of short duration, either naturally by placental transfer or artificially by injection of antibodies.

• Active immunity lasts for years and occurs naturally by infection or artificially by stimulation (vaccine) of immune defenses

Antibodies

Antibodies Mechanism of Action

Portal of Entry Sites

• Respiratory tract• GI tract• Genitourinary tract• Skin/mucous membranes• Bloodstream

Mode of Transmission

• Contact transmission by direct or indirect contact

• Droplet transmission such as in influenza• Airborne transmission such as in

tuberculosis• Contaminated food or water• Vector-borne transmission involving insect

or animal carriers, such as in Lyme disease

• Portal of exit

Physiologic Defenses Against Infection

• Body tissues• Phagocytosis• Inflammation• Immune systems:

• Antibody-mediated immune system• Cell-mediated immunity

Infection Control in Inpatient Health Care Agencies

• Health care–associated Infection (HAI) is acquired in the inpatient setting; not present at admission.

• Endogenous infection is from a patient’s flora.

• Exogenous infection is from outside the patient, often from the hands of health care workers.

Methods of Infection Control

• Practice hand hygiene and proper handwashing.

• Personal protective equipment (PPE).

Nurse in Personal Protective Equipment Caring for Patient in Protective Isolation Room

EDUCATION TO FAMILY ABOUT PPE

Infection Control

• Adequate staffing• Sterilization: free from all microorganisms

and spores• Disinfection: Kills most microorganisms but

not spores• Patient placement:

• Cohorting: pts with same illness placed together

• Patient transportation: PPE if necessary

CDC and Prevention Transmission–Based Guidelines

• Standard Precautions:• Respiratory hygiene/cough etiquette

(RH/CE)• Safe injection practices

Transmission-Based Precautions

• Airborne Precautions• Droplet Precautions• Contact Precautions

• KNOW PAGE 447

Methicillin-Resistant Staphylococcus Aureus (MRSA)

• Vancomycin• Linezolid• Community-associated MRSA• The best way to decrease the incidence of

this growing problem is health teaching• CONTACT PRECAUTIONS/ISOLATION

Other Multi Drug Resistant Organisms (MDROs)

• Vancomycin-resistant Enterococcus (VRE)• Multidrug resistant tuberculosis• Gonorrhea• Vancomycin-intermediate Staphylococcus

aureus (VISA)• Vancomycin-resistant S. aureus (VRSA)

Problems from Inadequate Antimicrobial Therapy

• Noncompliance (deliberate) or nonadherence (accidental)

• Legal sanctions that compel a patient to complete treatment, such as in the instance of tuberculosis (Directly Observed Therapy DOT)

• Septicemia• Septic shock

Collaborative Care

• History• Physical assessment and clinical

manifestations• Psychosocial assessment• Laboratory assessment including:

• Culture and antibiotic sensitivity testing• Complete blood count• Erythrocyte sedimentation rate• Serologic testing• Imaging assessment

Community-Based Care

• Home care management• Health teaching• Health care resources

NCLEX TIME

Question 1

How many inpatients acquire health care–associated infections yearly?

A. 500,000B. 1,000,000C. 1,500,000D. 2,000,000

Question 2

Cleansing hands with alcohol-based hand rubs is appropriate in which situation?

A. After administering medications to a patient

B. After working with a patient who has diarrhea due to Clostridium difficile

C. After using the bathroomD. To cleanse visibly soiled or sticky hands

Question 3

A patient who has been admitted for newly diagnosed tuberculosis will be placed on which Transmission-Based Precaution?

A. Droplet PrecautionsB. Airborne PrecautionsC. Respiratory PrecautionsD. Contact Precautions

Question 4

A patient may have infectious mononucleosis and is awaiting laboratory confirmation of this diagnosis. If the results are positive for infectious mononucleosis, the nurse would expect to see which laboratory result?

A. Increased neutrophil levels B. Decreased neutrophil levelsC. Decreased erythrocyte sedimentation rate D. Increased lymphocyte levels

Question 5

Which person has the highest risk for having Clostridium difficile–associated disease

(CDAD)?

A. A poultry farm worker B. A person who has eaten a hamburger that

was cooked rareC. A 2-year-old patient who has received IV

antibiotics for a week D. An 82-year-old patient who has received

IV antibiotics for a week