DefinitionAn infection is the result of an

interaction between a susceptible hose and an infectious agent (bacteria, viruses, fungi, parasites) a clinical syndrome caused by the invasion and multiplication of a pathogen in the body.

Localized

Systemic

The course of an infection can be divided into four major phases:

1. Incubation

2. Prodromal

2. Period of Clinical illness

3. Convalescence

Health Care institutions can present a danger in infectious disease transmission

‣Nosocomial infection - a hospital-acquired infection

‣Iatrogenic infection – a direct result of treatments

Goal 4 of the National Patient Safety Goals (NPSG’s) is directed toward infection related sentinel events: “Preventing health-care associated infections”.

Health care-associated infections are a serious problem and health care workers need to strive toward preventing the occurrence.

1. Skin and mucous membrane

2. Respiratory system

3. Gastrointestinal system

4. Circulatory system

1.Inflammatory response

Local reaction to an infectious agent Serves to localize, destroy, dilute,

neutralize, remove a pathogen Signs – redness, heat, swelling and pain

2. Immune response Immunity is a measure of a person’ s

ability to fight disease by forming immunoglobulins ( antibodies formed against invading antigens), or producing interferon.

Source of infection

Infectious agent

Reservoir

Portal of Entry to susceptible host

Portal of exit from Reservoir

Mode of transmission

Host Susceptibility

http://www.d.umn.edu/ehso/training/idp1.html

Infectious agent—bacteria, viruses, fungiReservoir—natural habitat of the organismPortal of exit—point of escape for the organismMeans of transmission—direct contact, indirect

contact, airborne routePortal of entry—point at which organisms enter a

new hostSusceptible host—must overcome resistance

mounted by host’s defenses

What is the type of organism – virus, bacteria, fungi, parasites, etc.

Level of virulence

Number of organisms

Number of organisms

Virulence

Competence of person’s immune system

Length and intimacy of contact between person and microorganism

Which of the following is the most significant and commonly found infection-causing agent in healthcare institutions?A. Bacteria

B. Fungi

C. Viruses

D. Mold

Answer: A. BacteriaRationale: Bacteria are the most significant infection-causing agents in the healthcare system. Bacteria can be categorized 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.

Other humans

Animals

Soil

Food, water, milk

Inanimate objects

Which one of the following infections or diseases may be spread by touching a contaminated inanimate article?A. RabiesB. GiardiaC. E. coliD. Influenza

Answer: D. InfluenzaRationale:Influenza may be spread if a person touches a contaminated article and then touches his eyes or nose.The reservoir for rabies is animals; for Giardia, water; and for E. coli, water or food.

Respiratory

Gastrointestinal

Genitourinary tracts

Breaks in skin

Blood and tissue

Direct contact

Droplets

Vectors

Airborne

Eyes

Mucous membranes

Respiratory tract

Placenta

Breaks in the host barriers

Lack of effective resistance

Changes in host defense

Tissue destruction

Intact skin and mucous membranesNormal pH levelsBody’s white blood cellsAge, sex, race, hereditary factors Immunization, natural or acquiredFatigue, climate, nutritional and general health

statusStressUse of invasive or indwelling medical devises

Use of invasive medical devicesAntibiotic-resistant organisms

developed in hospitals

Constant surveillance by infection-control committees and nurse epidemiologists

Written infection-prevention practices for all agency personnel

Hand hygiene recommendations Infection control precaution techniquesKeeping patient in best possible physical

condition

Incubation period—organisms growing and multiplying

Prodromal stage—person is most infectious, vague and nonspecific signs of disease

Full stage of illness—presence of specific signs and symptoms of disease

Convalescent period—recovery from the infection

In which of the following stages of infection is the patient most contagious?A. Incubation periodB. Prodromal stageC. Full stage of illnessD. Convalescent period

Answer: B. Prodromal stage

Rationale:The patient is most infectious during the prodromal stage when early signs and symptoms of the disease are present but are often vague and nonspecific. During this stage, the patient often does not realize he or she is contagious and spreads the infection.

Risk for Infection RT: Chronic disease Altered immune response Effects of medication Altered skin integrity Lack of proper immunization

The patient will:

1. demonstrate effective hand hygiene

2. identify the signs of infection

3. maintain adequate nutrition

4. demonstrate proper disposal of soiled articles.

Although it is impossible to ensure that the patient’s environment is free of microorganisms, there are many steps that a nurse can take to reduce the spread of microorganisms and thus promote safety for both the patient and the healthcare personnel.

Goal 4‣Reduce the risk of health care–associated infections.

According to the Centers for Disease Control and Prevention, each year, millions of people acquire an infection while receiving care, treatment, and services in a health care organization.

Consequently, health care-associated infections (HAIs) are a patient safety issue affecting all types of health care organizations.

The goal of QSEN is to address the challenge of preparing future nurses with the knowledge, skills and attitudes (KSA) necessary to continuously improve the quality and safety of the healthcare systems in which they work.

They have 6 competencies and Safety is one of the main competencies.

Infection control measures used in the hospital include:

‣Medical Asepsis‣Standard Precautions‣Isolation Precautions

Practices designed to reduce the numbers of pathogenic microorganisms and limit their growth and transmission in the patient’s environment

Definition:

1. Helps the patient fight a current infection and prevent its spread.

2. Prevents the patient from being re-infected by the same pathogen.

3. Prevents the patient from being infected with a new pathogen.

4. Prevents health care professionals and visitors who come in contact with the patient from being infected.

5. Helps decrease the chance of the patient acquiring a nosocomial infection. ◦ The infections can be simple and

uncomplicated, or major and life threatening. Patients are at risk for nosocomial infection because they often have weakened immune systems and because the health care facility contains patients and equipment that harbor infection.

The desired result is:

◦ to reduce the transmission of the microorganisms from one person to another.

◦ Or from one person to an object

The first line of defense in medical asepsis is hand hygiene.

Proper hand-hygiene is considered the single most effective way to stop the spread of microorganisms and preventing infection.

Reduction in the number of pathogens on the hands

Assess that the fingernails are short Highest concentration of organisms on

the hands are found UNDER THE NAILS.

Jewelry should be removed, especially rings with stones. Wedding bands may be worn sometimes.

Skin is free of lesions‣If the skin should have a small lesion,

bandage the area then double glove.

At the start of each shift

After sneezing or coughing

After using the bathroom

After handling contaminated items

Before and after giving patient care and between patients.

After handling body excretions- even with gloves on

Before and after performing any treatments

After removing gloves

At the end of each shift before leaving the health facility

WASH YOUR HANDS !

1. Hand-washing is one of the most effective methods of preventing the spread of bacteria.

2. Usually 15 seconds should be allowed to wash the hands

3. Clean from the cleanest area to the dirtiest area

wrist

Finger tips

4. These 3 are necessary to remove microorganisms

5. Do not touch the sink when washing hands – stand away

6. Keep clean items separate from dirty ones.

7. Turn off water with a dry paper towel – wet acts as a wick.

1. Friction

2. Running Water

3. Cleansing Agent

8. Jewelry makes it difficult to adequately cleanse the hands. It is best to not wear jewelry in the clinical setting. Wedding bands are acceptable sometimes.

9. If using hand lotion—allow hands to dry about 30 minutes before applying. Do NOT apply hand lotion immediately after washing hands.

Alcohol-based hand rubs (foam or gel) kill more effectively and more quickly than handwashing with soap and water.

They are less damaging to skin than soap and water, resulting in less dryness and irritation.

They require less time than handwashing with soap and water.

Bottles/dispensers can be placed at the point of care so they are more accessible.

HAND RUB (foam and gel) ‣Apply to palm of one hand (the amount used

depends on specific hand rub product).

‣Rub hands together, covering all surfaces, focusing in particular on the fingertips and fingernails, until dry. Use enough rub to require at least 15 seconds to dry.

ALCOHOL-BASED HAND RUBS ARE MORE EFFECTIVE IN KILLING BACTERIA THAN SOAP AND WATER.

Standard Precautions are:‣Those precautions designed for the care of all patients in hospitals regardless of their diagnosis or presumed infection status.

Set of guidelines developed by the Centers for Disease Control and Prevention (CDC) for preventing contact with potentially infectious blood or body fluids that may harbor diseases regardless of whether or not they contain visible blood

Standard Precautions

All body fluids, secretions and excretions regardless of whether or not they contain visible blood

Sputum, saliva Urine Feces Nasal secretions, tears Vomitus Spinal fluid/ cerebrospinal fluid Synovial, pleural, peritoneal , pericardial,

amniotic fluid All moist body surfaces, mucus

membranes Blood

Used for all patient’s, not just those with known infections

These precautions should be implemented whenever contact with potentially infectious material is anticipated.

Used to protect the caregiver.

1. Hand Hygiene 2. Personal Protective Devices

Gloves Mask, Eye Protection, Face Shield, Gown

3. Respiratory Hygiene/ Cough Etiquette4. Avoid recapping of needles; dispose of sharp objects

appropriately5. Handle Patient-care equipment appropriately6. Use adequate Environment controls 7. Review room assignments

Hands must be washed after patient contact regardless of the use of gloves. Even if you wear gloves, wash your hands

Gloved hands cannot be effectively washed.

Gloves can be used to avoid direct contact with infectious material

Wear gloves to handle:‣Blood‣Body fluids‣Secretions, Excretions‣Contaminated items

Change gloves before preceding to the next task, or touching non-contaminated items even on the same patient.

Made of vinyl or latex -- vinyl are used if allergy to latex is present.

Masks provide barrier protection against splashes and sprays, and airborne droplets

Masks come in various types depending on their permeability to airborne particles.

Eye goggles or glasses and face shields provide barrier protection against splashes and sprays.

Gown – should be water impermeable to provide barrier protection

Handle equipment in a manner that prevents personal skin and mucous membrane exposure and cross contamination to other patient’s.

Reusable equipment must be cleaned/ disinfected and reprocessed before using it in the care of another patient.

Each hospital, clinic has procedures for care, cleaning, and disinfection of environmental surfaces.

Spills of blood or body fluids need to be handled with special procedures.

Handled in a way to prevent contamination of skin, mucous membranes, and clothing.

Fold soiled linen with contaminated area to the inside. Do not shake.

Hold away from body and place in appropriate bag and dispose

of properly.

Place all sharp objects in a puncture-proof container.

Do not re-cap needles

Immediately discard after use. Do not attempt to bend or break a needle before discarding. Throw away the whole thing.

Isolation precautions are utilized when:‣patients have a greater susceptibility

to infection than others

‣A patient or patient’s body fluids are a carrier of microorganisms that can easily be transmitted to other patients, family members, or health care workers.

In addition to standard precautions, the CDC recommends three categories of transmission-based precautions. They include:‣1. Airborne precautions‣2. Droplet precautions‣3. Contact precautions

The fourth type of isolation is protective isolation.

Used when the organism is capable of remaining in the air for prolonged periods of time and can be transported in the air .

Most common organisms are:‣Tuberculosis‣Chicken pox‣Measles

Must wear a special particulate filter mask

A private negative air pressure room is used for patients needing airborne precautions.‣Negative air pressure rooms are used for

patients needing airborne precautions‣Bring air into the room from the hallway

and have a separate exhaust system. ‣Outside the room is isolation cart that

contains supplies needed to care for the patient and protects persons entering the room.

Caring for the patient in airborne isolation‣Personal Care - **Remember it is the

disease that is being isolated, not the patient. Place linens in proper contaminated –waste container, and soiled paper towels in an isolation waste container.

‣Food Service – disposable paper trays and disposable dishes that are discarded in proper isolation waste container. Do not put tray back on the food cart.

‣Contaminated articles – according to agency policy, usually double bagged or color-coded waste bags to indicate contaminated waste.

All patients on airborne precautions should wear surgical masks when leaving the negative air pressure room for

x-rays, tests, or procedures.

Organisms that can be spread by large-particle droplets.

Examples of organisms include:‣Influenza‣Cold‣Meningitis‣Mumps‣Pertussis

Single rooms are preferablePatients with same disease can

share the same roomStandard surgical masks and

gloves must be worn for anyone entering the patients room.

Gloves should be worn anytime handling tissues or items contaminated with the respiratory secretions

Keep visitors 3 feet from the infected patient.

Purpose is to prevent the transmission of disease by direct or indirect contact‣Direct contact involves:

Touching Bathing Skin-to-skin contact

‣Indirect contact involves: Contact with inanimate objects – doorknobs,

light switches, tabletops, telephonesExamples of diseases are: staph,

herpes, diphtheria, and many others

Contact precautions include use of barrier precautions such as gloves and impermeable gowns to prevent direct contact with infectious organism

Used:‣With patients who are infected by a multi-

drug resistant organism (MDRO)‣For patient with diarrhea‣When coming into contact with draining

wounds‣Patients with acquired antibiotic

resistance infections

Place the patient in a private room if possible

Wear PPE when entering the room for all interactions that may involve contact with the patient or contaminated areas in the patient’s environment

Remove PPE before leaving the room and perform hand hygiene

Avoid sharing patient-care equipment

You have gone in Mr. A.’s room to perform a dressing change.

What type of isolation is he in?

What equipment would you use?‣A. Gloves only‣B. Gloves and gown‣C. Gloves, gown, and mask

Used with patients who are immunocompromised such as:‣Chemotherapy‣AIDS‣Organ transplants

1. __ Influenza 2. __ Diarrhea 3. __ Tuberculosis4. __ AIDS5. __ Chicken pox6. __ Draining wound7. __ Chemotherapy

pt’s

A. Airborne B. Droplet C. Contact D. Protective /

Strict

Mrs. B. is on airborne isolation.

What specific equipment is used in airborne isolation that is not used in other types of isolation?

When would the nurse apply goggles or a face mask?