-
Clients in all health care settings are at risk for acquiring infections because of
- 1. lower resistance to infectious microorganisms
- 2. increased exposure to numbers & types of disease-causing microorganisms
- 3. invasive procedures
-
In acute care or ambulatory care facilities, clients can be exposed to
pathogens (some of which may be resistant to most antibiotics)
-
In all settings, clients & their families need to be able to recognize
sources of infections & institute protective measures
-
Client teaching needs to include
- 1. basic info on infections
- 2. various modes of transmission
- 3. methods of prevention appropriate to their care needs
-
Health care workers protect themselves from contact with infectious material, sharps injury, and/or exposure to a communicable disease by
- using knowledge of the infectious process
- appropriate personal protective equipment (PPE)
-
Which diseases require a greater emphasis on infection prevention & control techniques?
Hepatitis B, Hepatitis C, HIV, AIDS, TB & multidrug-resistant organisms
-
Infection
the entry & multiplication of an organism (infectious agent) in a host
-
pathogen
infectious agent
-
colonization
when a microorganism is present or invades a host, grows and/or multiplies but does not cause infection
-
An infectious disease
may not pose a risk for transmission
-
Illnesses like viral meningitis or pneumonia
- are infectious
- are possibly serious for client
- do not pose a risk to others, including caregivers
-
if the infectious disease can be transmitted directly from one person to another
communicable disease
-
if the pathogens multiply & cause clinical signs & symptoms
symptomatic infection
-
if clinical signs & symptoms are not present, illness is termed
asymptomatic
-
A communicable disease that can be asymptomatic
Hep C
-
Infection occurs in a cycle that depends on the presence of all of the following elements:
- infectious agent (pathogen)
- resevoir (source for pathogen growth)
- portal of exit (from reservoir)
- mode of transmission
- portal of entry (to host)
- a susceptible host
-
Microorganisms include
bacteria, viruses, fungi, & protozoa
-
Microorganisms on the skin are either
resident (normal flora) or transient flora
-
Resident (normal flora)
- permanent residents of skin
- survive & multiply without causing illness
- major part of body's protection
- covers entire exterior of body & protects against pathogens
- important to retain & maintain
-
transient microorganisms
attach to skin with contact w/ another person or object
-
potential for microorganisms or parasites to cause disease depends on the following factors:
- sufficient # of organisms (dose)
- virulence (ability to survive in the host or outsidebody)
- ability to enter & survive in host
- susceptibility of the host (host resistance)
-
sufficient # of organisms
dose
-
ability to survive in the host or outside the body
virulence
-
susceptibility of the host
host resistance
-
impaired immune system
immunocompromised
-
Resident skin microorganisms can cause serious infection when
- surgery or other invasive procedures allow them to enter deep tissues or when a client is severely immunocompromised
- *Resident flora is not virulent
-
a place where a pathogen can survive but may or may not multiply
reservoir
Ex: Hep A survives in shellfish but does not multiply, Pseudomonas organisms may survive & multiply nebulizer reservoirs
-
most common resevoir
human body
-
persons who show no symptoms of illness but who have pathogens on or in their bodies that can be transferred to others
carriers
-
To thrive, organisms require
a proper environment (including appropriate food, oxygen, water, temp, pH, & light)
-
Microorganisms require nourishment.
Clostridium perfringens (causes gas gangrene) thrives on ____________
Escherichia coli consume ____________
- organic matter
- undigested foodstuff in bowel
-
aerobic bacteria require
- oxygen for survival and for multiplication sufficient to cause disease
- **aerobic organisms cause more infections in humans when compared to anaerobic
- **ex: staphylococcus aureus and strains of streptococcus organisms
-
anaerobic bacteria thrive
- where little or no free oxygen is available
- **cause infections deep within pleural cavity, joint, or deep sinus tract
- **bacteria that cause tetanus, gas gangrene, & botulism are anaerobes
-
Clostridium difficile
an organism that causes antibiotic-induced diarrhea
-
Bacteria: Escherichia coli
Major Reservoir: ________
Major Infections/Diseases: __________
- colon
- gastroenteritis, UTI
-
Bacteria: Staphylococcus aureus
Major Reservoir: ___________
Major Infections/Disease: _________
- Skin, hair, anterior nares, mouth
- wound infection, pneumonia, food poisoning, cellulitis
-
Bacteria: Streptococcus (beta-hemolytic group A) organisms
Major Reservoir: ____________
Major Infections/Diseases: __________
- Oropharynx, skin, perianal area
- "Strep throat", rheumatic fever, scarlet fever, impetigo, wound infection
-
Bacteria: Streptococcus (beta-hemolytic group B) organisms
Major Reservoir: ___________
Major Infection/Diseases: ________
- adult genitalia
- UTI, wound infection, postpartum sepsis, neonatal sepsis
-
Bacteria: Mycobacterium tuberculosis
Major Reservoir: ___________
Major Infection/Disease: __________
- droplet nuclei from lungs, larynx
- tuberculosis
-
Bacteria: Neisseria gonorrhoeae
Major Reservoir: __________
Major Infection/Diseases: __________
- Genitourinary tract, rectum, mouth
- Gonorrhea, pelvic inflammatory disease, infectious arthritis, conjunctivitis
-
Bacteria: Rickettsia rickettsii
Major Reservoir:____________
Major Infection/Diseases:____________
- wood tick
- Rocky Mountain spotted fever
-
Bacteria: Staphylococcus epidermis
Major Reservoir: __________
Major Infection/Diseases: __________
- Skin
- Wound infection, bacteremia
-
Virus: Hepatitis A
Major Reservoir: ____________
Major Infection/Diseases: __________
-
Virus: Hepatits B
Major Reservoir: __________
Major Infection/diseases: _________
- blood & certain body fluids, sexual content
- Hepatits B
-
Virus: Hepatitis C
Major Reservoir: __________
Major Infection/Disease: _________
- blood, certain body fluids, sexual contact
- Hepatits C
-
Virus: Herpes simplex virus (type 1)
Major Reservoir: _________
Major infection/disease: _________
- Lesions of mouth or skin, saliva, genitalia
- cold sores, aseptic meningitis, STD, herpetic whitlow
-
Virus: Human Immunodeficiency virus (HIV)
Major Reservoir: ___________
Major Infection/Disease: ________
- blood, semen, vaginal secretions via sexual contact
- acquired immunodeficiency syndrome (AIDS)
-
Fungi: Aspergillus organisms
Major Reservoir: ________
Major Infection/Disease: __________
- soil, dust, mouth, skin, colon, genital tract
- Aspergillosis, pneumonia, sepsis
-
Fungi: Candida albicans
Major Reservoir: __________
Major Infection/Disease: _________
- mouth, skin, colon, genital tract
- Candidiasis, pneumonia, sepsis
-
Protozoa: Plasmodium falciparum
Major Reservoir: _________
Major Infection/Disease: ________
-
Most organisms require water or moisture for survival. A frequent place for microorganisms is
the moist drainage from a surgical wound
-
spore
- a bacteria that is resistant to drying
- spore-forming bacteria include organisms like those that cause anthrax, botulism, and tetanus
-
Microorganisms can live only in certain temp ranges. Each species of bacteria has a specific temp at which it grows best. The ideal temp for most human pathogens is
- 20 to 43 degrees Celsius (68 to 109 degrees F)
- some can survive temp extremes that would be fatal to humans
-
bactericidal
a temperature or chemical that destroys bacteria
-
bacteriostasis
growth and reproduction of bacteria?
-
acidity of an environment determines
the viability of microorganisms
-
most microorganisms prefer an environment within a pH range of
5-7
-
bacteria thrive in urine with an
alkaline pH
-
most organisms cannot survive the acid environment of the
stomach
-
Acid-reducing medications (antacids and H2 blockers) may cause an __________________, which can contribute to _________________.
- overgrowth of gastrointestinal organisms
- health care-associated pneumonia in a client receiving these meds
-
Microorganisms thrive in ____________ environments such as those ____________.
(Light)
- dark
- under dressings and within body cavities
-
after microorganisms find a site to grow and multiply, they must find a ____________ if they are to enter another host and cause disease
portal of exit
-
portals of exit include:
sites such as blood, skin & mucous membranes, respiratory tract, genitourinary tract, gastrointestinal tract, and transplacental (mother to fetus)
-
the presence of purulent drainage is a
potential portal of exit
-
skin may be considered a portal of exit because any ____________ may allow pathogens to exit the body
break in the integrity of skin and mucous membranes
-
Pathogens that infect the respiratory tract (like Mycobacterium tuberculosis or influenza virus) can be released from the body when ______________
an infected person sneezes or coughs
-
clients with artificial airways such as tracheostomy or endotracheal tubes, organisms easily exit the ____________ through these devices when the device is ________________
- respiratory tract
- manipulated or sunctioned
-
Normally urine is sterile. However, when a client has a ____________, microorganisms exit during urination or through urinary diversions such as ____________
- UTI
- ileostomies and suprapubic drains
-
The _____________ is one of the most bacterially contaminated sites of the human body, but most of the organisms are ______________.
-
Organisms that are normal flora in one person can be _________ in another
pathogens
-
Gastrointestinal tracts include
mouth, bowel elimination, drainage of bile via surgical wounds, or drainage tubes
-
HIV is present in much ___________ numbers in semen than in female vaginal secretion
higher
-
Blood is normally a sterile body fluid, but in the cases of _________ such as __________________ it becomes a reservoir for pathogens
- communicable diseases
- Hep B or C, HIV
-
each disease has a specific mode of
transmission
-
vector
- something that transmits a virus
- ex: some types of encephalitis are transmitted by infected mosquitos, the mosquito serves as a vector transmitting the virus when it bites the host
-
Varicella zoster (chicken pox) may be spread by
the airborne route in droplet nuclei or by direct contact (some microorganisms may be transmitted by more than one route)
-
The major route of transmission for pathogens identified in the health care setting is the
unwashed hands of the health care worker
-
organisms enter the body through ____________ they use for exiting
the same routes
-
Factors that reduce the body's defenses __________ the chances of pathogens entering the body
enhance
-
whether a person acquires an infection depends on ______________ to an infectious agent
susceptibility
-
______________ depends on the individual degree of resistance to a pathogen (immune response)
susceptibility
-
The more _________ an organism, the _________ the dose, the more likely a person will develop an infection
-
Some of the factors that influence a person's susceptibility (resistance) include
age, nutritional status, presence of chronic disease, trauma, and smoking
-
Organisms with resistance to key antibiotics are becoming ____________ in health care settings, but especially ___________
- more common
- acute settings
-
the resistance to key antibiotics is associated with
the frequent and sometimes inappropriate use of antibiotics over the years in all settings (acute care, ambulatory care, clinics, and long term care)
-
what are the modes of transmission?
Contact, Airborne, Vehicles, Vector
-
the three contact routes of transmission are
direct, indirect, and droplet
-
person-to-person (fecal,oral) or physical contact between source and susceptible host (touching client feces and then touching your inner mouth or consuming contaminated food) is what kind of contact
direct
-
personal contact of susceptible host with contaminated inanimate object (e.g. needles or sharps objects, dressings, environment)
indirect contact
-
large particles that travel up to 3 feet and come in contact with susceptible host (coughing, sneezing, or talking)
droplet
-
droplet nuclei, or residue or evaporated droplets suspended in air (coughing, sneezing,) or carried on dust particles
airborne
-
contaminated items, water, drugs, solutions, blood, food (improperly handled, stored, or cooked; fresh or thawed meats) are what type of contact?
vehicles
-
external mechanical transfer (flies, mosquitos, louse, flea, tick)
vector
-
When the client acquires an infection observe for
signs and symptoms of infection and take appropriate actions to prevent its spread
-
The severity of the client's illness depends on the _________ of the infection, the ___________ of the microorganisms, ____________ of the organism , and the ____________ of the host.
- extent
- pathogenicity
- dose
- susceptibility
-
example of a localized infection
wound infection
-
if an infection is localized the patient usually experiences ___________ symptoms
localized
-
an infection that affects the entire body instead of just a single organ or part is
systemic (can become fatal if undetected and untreated)
-
the course of the infect influences the
level of nursing care provided
-
supportive therapy to bolster the defenses against the infectious process includes
providing adequate nutrition and rest
-
if a nurse has an open area too large to be covered with a dressing,
the nurse should not perform client care procedures
-
normal body flora that reside inside and outside of the body protect
a person from pathogens
-
linings of the nasal passageways act to
prevent organisms from entering the lungs
-
a protective reaction that serves to neutralize pathogens and repair body cells
inflammatory response
-
Each ____________ has defense mechanisms that work to prevent exposure to infection
organ system
-
What are the nonspecific defenses that protect against microorganisms regardless of prior exposure?
normal flora, body system defenses, and inflammation
-
the immune system is composed of ______________ that help the body resist disease
specific cells
-
There are _________ and ________ responses of the immune system
- non specific
- specific defenses against specific pathogens
-
a person normally excretes ___________ of microbes daily through the intestines
trillions
-
normal flora of the ____________ exist in large numbers without causing illness
large intestine
-
normal flora excrete __________ within the intestine walls
antibacterial substances
-
the skin's normal flora exert a protective, bactericidal action that
kills organisms landing on the skin
-
the use of broad-spectrum antibiotics for the treatment of infection can lead to
suprainfection
-
develops when broad-spectrum antibiotics eliminate a wide range of normal flora organisms, not jus those causing infection
suprainfection
-
What three organ systems are easily accessible to microorganisms
skin, respiratory tract, and gastrointestinal tract
-
hairlike projections in the airways of lungs that rhythmically beat to move mucus or cellular debris up to pharynx to be expelled
cilia
-
the body's cellular response to injury, infection, or irritation
inflammation
-
a protective vascular reaction that delivers fluid, blood blood products, and nutrients to an area of injury
inflammation
-
interval between entrance of pathogen and appearance of first symptoms
incubation period
-
interval from onset of nonspecific signs and symptoms (malaise, low-grade fever, fatigue) to more specific symptoms. During the time, microorganisms grow and multiply and client may be capable of spreading disease to others.
prodromal stage
-
interval when client manifest signs and symptoms specific to type of infection
illness stage
-
interval when acute symptoms of infection disappear (length of recovery depends on severity of infection and client's host resistance; recovery may take several days to months)
convalescence
-
What are the stages of the course of infection
- Incubation Period
- Prodromal Stage
- Illness Stage
- Convalescence
-
-
signs of localized inflammation may include
swelling, redness, heat, pain, tenderness, and loss of function to affected body part
-
signs of systemic inflammation
fever, leukocytosis, malaise, anorexia, nausea, vomiting, lymph node enlargement, or organ failure
-
the inflammatory response may be triggered by
- physical agents (trauma, temp extremes, radiation)
- chemical agents (external & internal irritants such as harsh poisons or gastric acid)
- microorganisms
-
What response is this?
1. Vascular and cellular responses
2. Formation of inflammatory exudates
3. Tissue repair
inflammatory response
-
exudates
fluid and cells that are discharged from cells or blood vessels (pus or serum)
-
acute inflammation is an immediate response to
cellular injury
-
the redness of inflammation is caused by
the increase in local blood flow near the location of the injury (occurs through vasodilation)
-
localized warmth at site of inflammation is caused by
greater volume of blood at site
-
local vasodilation delivers_________ and ________ to injured tissues
-
kinin, vasoactive amines, prostaglandins, and certain complement components that play a major role in inflammation
serum proteins
-
serum proteins serve to increase
vasodilation
-
these are present at the site of infection and serve as the first line of defense from microorganisms
neutrophils
-
-
pain of inflammation is caused by
increased pressure on nerve endings
-
injury causes tissue damage and possibly necrosis, as a result the body releases chemical mediators that increase ______________; as a result, fluid, protein, & cells enter interstitial spaces; this accumulation of fluid causes localized _____________
- permeability of small blood vessels
- edema (swelling)
-
the eyes defense mechanism against infection
tearing and blinking
-
defense mechanism of respiratory tract
cilia lining upper airway, coated by mucus; macrophages
-
defense mechanisms of urinary tract against infections
- flushing action of urine flow
- intact multilayered epithelium
-
defense mechanisms of GI tract against infections
- acidity of gastric secretions
- rapid peristalsis in small intestine
-
defense mechanism of vagina against infection
normal flora causing vaginal secretions to achieve low pH (at puberty)
-
defense mechanisms of mouth against infection
- intact mutlilayered mucosa
- saliva
-
defense mechanisms of skin against infection
- intact, multi-layered surface
- shedding of outer layer of skin cells
- sebum
-
contains fatty acid that kills some bacteria
sebum
-
body's first line of defense against infection
skin
-
a process that involves the destruction and absorption of bacteria
phagocytosis
-
cellular response of inflammation involves
WBCs arriving at the site
-
which WBCs specialize in process of phagocytosis
neutrophils and monocytes
-
an increase in the number of circulating WBCs ( the body's response to WBCs leaving blood vessels)
leukocytosis
-
normal serum WBC: ________
during inflammation: _________
- 5000-10,000/mm3
- 15,000-20,000/mm3 and higher
-
Fever is caused by phagocytic release of ___________ from bacterial cells that cause a rise in the ______________ set point
-
Exudate may be ____________ , _________ , or ________.
- serous
- sanguineous
- purulent
-
serous
clear, like plasma
-
sanguineous
containing red blood cells
-
purulent
containing WBCs and bacteria
-
fibrinogen
a plasma protein (that with platelets forms a meshlike matrix at the site of inflammation to prevent its spread)
-
tissue that is not as strong as tissue collagen and assumes the form of scar tissue when inflammation is chronic
granulation tissue
-
Health care-associated infections (HAIs) are formerly called what
nosocomial or health care-acquired infections
-
infections that result from delivery of health services in a health care facility
Health care-associated infections (HAIs)
-
a type of HAI from a diagnostic or therapeutic procedure
Iatrogenic infection (ex: after a GI endoscopy, client developed P. aeruginosa)
-
HAIs are either ______ or _________.
-
organism that is present outside the client (HAI)
postoperative infection
exogenous
-
organism that are part of normal flora or virulent organisms residing that could cause infection (HAI); can occur when part of the client's flora becomes altered and an overgrowth results (ex: client is placed on several antibiotics in hospital setting and develops an infection)
endogenous infection
-
the major sites for HAIs include
- surgical or traumatic wounds
- urinary & respiratory tracts
- bloodstream
-
TJC has listed several national safety goals focusing on care of older adults, such as
- influenza and pneumonia vaccine
- preventing pressure ulcers
-
an age-related decline in immune system function
immune senescence
-
older adults are less capable of producing ___________ to combat challenges to the immune system
lymphocytes
-
risks associated with the development of HAIs in older clients
- poor nutrition
- unintentional weight loss
- low serum albumin levels
-
after age 70, older adults appear likely to produce _________ that attack parts of the body itself instead of infections
autoantibodies
-
infants have immature defenses against infection because
they are born only with the antibodies provided by the mother (their own immune system is not capable of producing the immunoglobulins and WBCs to adequately fight some infections)
-
breast fed infants have greater what?
immunity than bottle fed infants (they receive antibodies thru the milk)
-
what are the most common cause of communicable illness in young or middle-age adults
viruses
-
what infection in children and adolescents has been decreased by 98% since the major effort to vaccinate all children in 2000?
hepatitis B
-
the immune response, particularly ____________, declines with age
cell-mediated immunity
-
when protein intake is inadequate as a result of poor diet or debilitating disease, the rate of ______________ exceeds that of _______________/
- protein breakdown
- tissue synthesis
-
what nutrients are important for the body's defenses against infection and impairs wound healing?
proteins, carbohydrates, and fats
-
the body responds to emotional or physical stress by the
general adaptation syndrome
-
the basal metabolic rate increases as the body uses energy stores
alarm stage
-
infected drainage may be what color
yellow, green, or brown (depending on the pathogen)
-
Nursing Assessment Questions relating to infections
- Risk factors
- Possible existing infections
- Med history
- Stressors
-
lab value for WBC cournt
5,000-10,000/mm3
-
Lab value for erythrocyte sedimentation rate
- up to 15mm/hr for men
- up to 20 mm/hr for women
-
lab value for iron level
60-90g/100mL
-
Differential Count (% of each type of WBC)
Neutrophils:
Lymphocytes:
Monocytes:
Eosinophils:
Basophils
- 55-70%
- 20-40%
- 5-10%
- 1-4%
- 0.5-1.5%
-
a risk for infection is a WBC of __________
less than 5,000/mm3
-
potential sites of infection
- IV catheter in right forearm (in place for 3 days)
- foley catheter draining cloudy amber-colored urine
-
to identify the causative organism, the nurse collects
specimens of body fluids such as sputum or drainage from infected body sites for cultures
-
systemic infections require measures to prevent
complications of fever
-
a client's increased metabolic rate with infection requires an
adequate nutritional intake
-
base efforts to minimize the onset and spread of infection on the principles of
aseptic technique
-
the absence of pathogenic (disease-producing) microorganisms
asepsis
-
practices/procedures that assist in reducing the risk for infection
asepsis technique
-
the two types of aseptic technique are
medical and surgical asepsis
-
procedures used to reduce the number of organisms present and prevent the transfer of organisms
(hand hygiene, using gloves)
medical asepsis (clean technique)
-
object that becomes unsterile or unclean is considered
contaminated
-
to prevent and control infection and its spread
standard precautions
-
using an instant alcohol hand antiseptic
hand hygiene
-
act of washing hands with soap and water
hand washing duh
-
________________ is the removal of all soil (organic & inorganic material) from objects & surfaces; generally involves water & mechanical action with detergents or enzymatic products
cleaning
-
detergents should have a ______________ pH
natural
-
failure to follow the manufacturer's recommendations transfers liability from the ___________ to the ________ if an infection occurs from improper processing
manufacturer, health care facility or agency
-
Cleaning Equipment:
When first rinsing the equipment, you use what temp of water? When rinsing the equipment after cleaning, you use what temp of water?
-
a process that eliminates many or all microorganisms, with the exception of bacterial spores, from inanimate objects
disinfection (there are two types)
-
what are the two types of disinfection?
- disinfection of surfaces
- high-level disinfection (endoscopes/bronchoscopes)
-
what do you use to accomplish disinfecting
- a chemical disinfectant or wet pasteurization (used for respiratory therapy equipment)
- ex of disinfectants are alcohols, chlorides, glutaraldehydes, hydrogen peroxide, and phenols
-
the complete elimination or destruction of all microorganisms, including spores
sterilization
-
what are the most common sterilizing agents?
- steam under pressure
- ethylene oxide (ETO) gas (poses potential risk to staff; exposure should be monitored)
- hydrogen peroxide plasma
- chemicals
-
what are the three categories of device classification for sterilization, disinfection, and cleaning?
- Critical Items
- Semicritical Items
- Noncritical Items
-
critical items must be _________
sterile
-
semicritical items must be _________________ or __________
- high-level disinfected (HLD)
- sterilized
-
noncritical items must be _______________
disinfected
-
___________ use moist heat from steam to sterilize items
autoclave
-
How does ethylene oxide (ETO) gas destroy spores and microorganisms?
by altering cells' metabolic processes
-
what is cough etiquette
covering mouth/nose when sneezing/coughing, using a tissue, prompt disposal of tissue, then hand hygiene
-
a nurse who has a _________________ should be placed on work restriction
upper respiratory infection
-
as long as urinary catheters and drainage sets are closed and intact, they are considered ___________
sterile
-
______________ on drainage bags should remain closed to prevent entrance of bacteria
outflow spigots
-
make sure the site from which a drainage tube exits remains clear of ________ or ____________
- excess moisture
- accumulated drainage
-
you only open drainage receptacles when it is necessary to _______ or _________
- discard
- measure the volume of the drainage
-
the surgical wound is considered to be _________
sterile
-
to prevent entry of microorganisms into the wound, always clean ________ from wound site
outward
-
a client's resistance to infection improves as the nurse protects ________ against infection
normal body defenses
-
S. aureus
MRSA (methicillin-resistant)
-
the separation and restriction of movement of ill persons with contagious disease
Isolation
-
_____________ includes the appropriate use of gowns, gloves, masks, eyewear, and other protective devices or clothing
barrier precautions (depends on the task being performed)
-
Centers for Disease Control & Prevention Isolation Guidelines has a two-tiered approach.
First Tier:
Two Tier:
- Standard Precautions
- Transmission Categories
-
wear _____________ when you anticipate splashing or spraying of blood or body fluid into the face or when working with a client placed on airborne or droplet precautions
full-face protection (eyes, nose, and mouth covered)
-
when collecting a specimen, put it in a medium that __________________
promotes growth of organisms
-
____________ reports determine the antibiotics used in treatment
sensitivity
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