Patients are at risk for acquiring infections due to:
- Lower resistance to pathogens
- Increased exposure to pathogens-some of which are resistant to most antibiotics
- Invasive procedures
Health care workings are at risk for acquiring infections due to:
Contact with patient blood, body fluids and contaminated equipment and surfaces.
Invasion of a susceptible host by pathogens or microorganism resulting in disease.
The presence and growth of microorganisms with a host but without tissue invasion or damage.
Illness that is serious for patient but have a low/no risk for transmission (pneumonia, viral meningitis)
Can be transmitted from one person to another
Chain of infection
- Infectious agent
- Portal of Exit
- Mode of Transmission
- Portal of Entry
- Susceptible Host
- bacteria, viruses, fungi, Protozoa
- resident or transient flora
- virulence-ability to produce disease
- their ability to enter and survive in the host
-place where microorganisms survive, multiply and await transfer to susceptible host.
Insects, food, water, organic matter or inanimate surfaces
Common reservoirs for health care-associated infections (HAI’s) include:
Health care workers hands, patients, equipment and the environment.
Optimal Conditions of the Reservoir: Food
Nourishment in the form of organic or inorganic matter
Optimal Conditions of the Reservoir: Oxygen
Aerobic-requires O2 (s. Aureus), Anaerobic-requires little or no O2
Optimal Conditions of the Reservoir: Water
Moist environment. May form a “spore” which is resistant to drying (C-diff)
Optimal Conditions of the Reservoir: Temperature
Cold tends to prevent growth
Optimal Conditions of the Reservoir: pH
The acidity of the environment
Optimal Conditions of the Reservoir: Light
Thrive in dark environments
Portal of Exit includes sites such as
- Blood: normally sterile. With Hep B, C r HIV becomes a reservoir/portal
- Skin and mucous membranes: any break in the skin or mucous membranes allows pathogens to exit the body
- Respiratory Tract: cough and sneeze
- GI/GU tract: mouth, stool, urine, saliva, sputum, wound drainage.
- Reproductive tract: mother to fetus, sexual contact
Mouth is the most
Bacterial lay contaminated parts of the body
Modes of Transmission
Person to person
Person touching contaminated inanimate object
Large particles that travel up to 3 feet during coughing, sneezing or talking
Smaller droplets suspended in air for longer periods of time
contaminated items: food, drugs, blood, food
Flies, mosquitos, louse, fleas, ticks either external or internal transmission (between parasite and host)
Depressed immune system reduces the body’s defenses therefore
increasing the chance of pathogens entering the body.
Portals of Entry
- Respiratory tract
- GI tract (mouth)
- GU tract (poor peri are, Foley catheters)
A susceptible individual to the strength and numbers of microorganisms
Factors that make people susceptible to infection include
Age, nutritional status, presence of chronic disease, trauma and smoking.
Frequent and inappropriate use of antibiotics over the years is associated with an
Increased resistance to microorganisms.
The chain of infection can be interrupted by following the standard precautions/infection prevention:
- Hang hygiene
- Education using cough etiquette
- Proper use of PPE (Personal Protective Equipment)
- Proper use of isolation procedures
Localized symptoms: pain, tenderness, redness at the site, edema, heat, and loss of function in the affected body part.
Affects the entire body’ fever, leukocyte sits, malaise, n/v, organ failure(sepsis)
Fatal if untreated
Some of the body’s natural defenses include
Normal floras and inflammation
Participate in maintaining health when residing in their usual area’ skin, wall of the intestine
Use of ____________________ disrupt the normal floras. This can lead to __________________.
Use of BROAD SPECTRUM ANTIBIOTICS disrupt the normal floras. This can lead to A SUPRAINFECTION BY KILLING OFF THE BODY’S OWN NORMAL FLORA IN ADDITION TO THE INVADING ORGANISMS.
- Cellular response of the body to injury, infection or irritation.
- Protective vascular reaction that delivers fluid, blood products and nutrients to an injured area of the body.
Destruction and absorption of bacterial neutrophils and monocytes (WBC’s) ingest and destroy microorganisms.
Serous (clear), sanguine out (containing blood, purulent (contain WBC’s and bacteria-Puss)
HAI’s (Health Care Associated Infections)
-Aka Nosocomial infections
What causes HAI’s?
- invasive procedures
- antibiotic administration
- presence of multi-drug resistant organisms
- breaks in infection prevention and control measures.
Patients at risk for HAI’s include
Usually older adults, poorly nourished and have multiple illnesses/co-morbidities (diabetes, malignancies) causing a lowered resistance to infection.
Inadvertent adverse effect or complications directly resulting from a diagnostic or therapeutic procedure such as a surgical infection.
HAI’s are considered what type of infection
Infection from organisms found outside the body (salmonella, tetanus)
Infection from the patient’s own flora (C-diff)
Major sites for HAI’s include:
- Surgical or traumatic wounds
- urinary and respiratory tracts
- bloodstream infections
How does HAI’s affect health care?
- Significantly increases the cost of health care.
- often costs for HAI’s are not reimbursed by CMS/insurance centers
- Prevention of infection has a beneficial financial impact.
Factors Influencing Infection Prevention and Control
- Nutritional Status
- Disease Process
How Age influences infection prevention and control?
Very young and older adults.
- immunizations at all ages
- education on healthy/risky behaviors
- mothers breastfeeding infants. (Infant receives mothers antibodies though the breast milk)
How Nutritional Status influences infection prevention and control?
- Direct influence on susceptibility.
- Poor intake of protein, nutrients, carbs, impairs wound healing and body defenses against infection.
How stress influences infection prevention and control?
Includes emotional and physical stress.
-general adaptation syndrome/stress response: cortisone levels increase resulting in decreased resistance to infection.
How does the disease process influence infection prevention and control?
Diseases of the immune system present the greatest risk.
How does diseases like Leukemia, AIDS, lymphoma, and cancer influence infection prevention and control?
Inability to produce enough WBC to fight infection.
General debilitation and nutritional impairment.
How do chronic diseases such as diabetes influence infection prevention and control?
Poor nutritional status and general debilitation.
How does diseases such as emphysema and bronchitis influence infection prevention and control?
Impairs ciliary action.
How does peripheral vascular disease and burns influence infection prevention and control?
Decreases blood flow to injured tissues and increases susceptibility to infection.
Always make ___________ clinical decisions
Conduct a thorough physical assessment including:
- travel history, immunization/vaccination history
- medication history/therapy: meds that compromise immunity, OTC/herbals
- status of defense mechanisms: breaks in the skin, ability to cough
- patient susceptibility: age, nutritional status, stress, disease process
- laboratory findings, WBC’s, blood cultures
Look for S&S of localized and/or systemic infection:
Localized and systemic
The accuracy of the diagnosis depends on the accuracy of the R/T factors (clusters of assessment data), which then influences establishing a measurable outcome and individualized nursing interventions.
*ALWAYS PRIORITIZE YOUR NURSING DIAGNOSIS
Types of Outcomes include
- Purposeful - uses action verbs
- Time Specific - ex) by discharge, by the end of my teaching session
Collaborate with patient, family and interdisciplinary health care team.
Health Promotion (Implementation)
- Use critical thinking skills to prevent infection from developing or spreading
- encourage immunization so
- eliminate reservoirs of infection including ports of exit and entry
- prevent transmission
- implement techniques/procedures to prevent spread of infection to yourself and others
- maintain the patients skin integrity
By choosing the appropriate individualized diagnosis, outcome and interventions, you can then implement measures to effectively reduce the risk of infection
Were outcomes achieved?
- Document patient responses to treatments
- Revise what isn’t working
- Marks as “complete” the nursing diagnosis that are solved and no longer applicable (saves the time of your peers in re-asking the patient about resolved issues.)
Absence of disease-producing microorganisms. Refers to the techniques/procedures to help reduce infection
All precautions used as a general rule to help prevent the spread of infection: hand hygiene, the use of PPE
“Clean technique”. Procedures used to REDUCE the number of microorganisms.
Ex) hand hygiene, Barriers, PPE, routine environmental cleaning.
(Sterile Technique) considered FREE of microorganisms.
Ex) during the insertion of IV’s, central lines, Foley Catheters, and any procedure that requires intentional perforation of the patient’s skin.
_____________ are a primary source of transmitted infection.
Contaminated hands of health care workers.
Washing with soap and water
Using friction followed by rinsing underwater for 15 sec.
Used when hands are visibly dirty, soiled from blood/body fluids.
Also when dealing with c-diff, before and after using the toilet.
Alcohol based hand antiseptic is used when
- hands are not visibly soiled
- routine decontamination before, after and between patient contact.
- moving from a contaminated to clean body site during patient care
- before donning sterile gloves
- after removing gloves
- before caring for patients with severe neutropenia/immune suppression
Information regarding PPE
- don’t wear outside of patients room
- do not wear gloves outside of a patients room unless you are carrying waste to a dirty utility room.
- a mask that has become moist does not provide a barrier to microorganisms and is ineffective
- N95 respirators are specially fit annually. No students are to care for patients that require the use of an N95 mask.
- eye glasses are not the same as protective goggles
- Change gloves as many times as necessary in the patient’s room
- any sterile surface that becomes wet is no longer sterile
- wear as much PPE as you want anytime you want
-do not forget to teach the patient and family the proper techniques for the spread of infection including:
Hand hygiene, use of PPE, the reason for isolation practices and cough etiquette.
The restriction of movement for ill persons with contagious diseases.
CDC (2007) Two-tier approach
- Standard Precautions
2. Isolation Precautions
Isolation precautions is based on
The mode of transmission of a disease. Diligent use of infection prevention principles.
Isolation Precautions against airborne
TB, negative airflow rooms, and N95 respirator mask
Isolation Precautions for Protective Environments
(Reverse isolation-immune compromised positive air flow) No plants or flowers.
Psychological Implications of Isolation
-Isolation may leave patient feeling lonely, depressed, rejected, embarrassed, etc.
Tips for the Psychological Implications of Isolation
- explain the reason for isolation measures to patient and family; explain the nature of the disease and importance of carrying out procedures
- when performing patient care, don’t rush in and out of the room-may leave patient feeling more isolated
- teach the patient and family the correct isolation practices.
-all health care workers are at an increased risk for acquiring infections
Needlestick Safety and Prevention Act
- all sharp boxes need to be available at the site of use
- implementation of safety needle devices
- report exposure to contamination/needle sticks immediately (exposure to eyes, open skin areas, mouth, nares)
Patient Source Testing
Patients are tested upon the report of a needle stick or contamination by a health care worker; depending on the state, may be required or may require patient consent.
If patient tests positive for a pathogen or if the source patient is unknown,
Prophylactic treatment is recommended for employee.