Nursing Care of Patients with Infections Chapter 8 Nursing Care of Patients with Infections

Infectious Process Chain of Infection Required Six Links in the Chain Treatment Breaks the Chain

Chain of Infection

Link 1: Reservoir Environmental Home for Infectious Agents Animate: People, Insects, Animals, Plants Inanimate: Water, Soil, Medical Devices

Link 2: Causative Agents Bacteria Virus Fungi Protozoa Helminth Prion

Key Terms Normal Flora: Microbes Occurring Naturally in a Body Part Pathogens: Disease-causing Microbe

Link 3: Mode of Transmission Direct Contact Indirect Contact Airborne

Direct Contact Direct Contact Touching Biting Kissing Sexual Contact Droplet Spray

Direct Contact (cont’d) Prevention Hand Hygiene Aseptic Technique Personal Protective Equipment (Gloves, Surgical Masks, Goggles, Gowns, Shoe Covers)

Personal Protective Equipment

Indirect Contact Vehicle-borne Transmission by Contact with Contaminated Object Prevention Hand Hygiene, Excellent Cleaning Stethoscope Cleaning Clean Water/Food

Indirect Contact (cont’d) Vector-borne Transmission by Living Source Other Than Humans Prevention Insect Repellants Rodent Control

Airborne Transmission by Particles Floating in Air Inhaled or Deposited on Mucous Membranes Prevention High-efficiency Particulate Air (HEPA) Respirators

Link 4: Portal of Entry Entry into Susceptible Host

Portals Respiratory Tract Skin Mucous Membranes Gastrointestinal Tract Genitourinary Tract Placenta

Link 5: Susceptible Host From Defense Breakdown

Increased Risk Very Young or Old Age Malnourishment Immuno-compromised Chronic Disease Stress Invasive Procedures

Link 6: Exit Portal Route Infectious Agent Uses to Leave Host Who Has Become Reservoir for Infection

Body’s Defense Mechanisms Skin and Mucous Membranes Cilia Gastric Juices Immunoglobulins Leukocytes and Macrophages Lysozymes

Body’s Defense Mechanisms (cont’d) Interferon Inflammatory Response

Inflammatory Response Vascular Response Inflammatory Exudate Phagocytosis and Purulent Exudate

Immune System Body’s Final Defense Against Infection Immune Cells and Lymphoid Tissue

Infectious Disease Results When Immune System Protection Fails

Localized Infection Microbes in One Area Pain, Redness, Swelling, Site Warmth

Generalized Infection Systemic Involvement Signs and Symptoms Headache, Muscle Aches, Fever, Anorexia Sepsis Infection That Has Spread to Bloodstream

Laboratory Assessment Gram’s Staining Culture and Sensitivity Antibody Test CBC with Differential Erythrocyte Sedimentation Rate

Immunity Ability of Body to Protect Itself from Disease

Immunity (cont’d) Natural Immunity Innate Immunity Acquired Immunity

Example of Infectious Disease Mononucleosis

Mononucleosis Epstein-Barr Virus Contagious (“Kissing Disease”) Extreme Fatigue, Anorexia, Chills Red Sore Throat, Headache, High Fever, Tonsils with a White Coating Supportive Care

Community Infection Control World Health Organization Centers for Disease Control and Prevention Local Health Departments Home Health Nurse

Infection Control in Health-Care Agencies Community-acquired Infection Nosocomial Infection Hand Hygiene

Nosocomial Infections Infection from Stay in Health-care Agency Risk Factors Host’s Condition Multiple Antibiotic Therapy High-risk Units

Nosocomial Infections (cont’d) Common Pathogens Escherichia coli (E. coli) Staphylococcus aureus Pseudomonas aeruginosa

Hand Hygiene Before and After Patient Contact Glove Use

Hand Hygiene (cont’d) Wet Hands, Soap, Lather 15 Seconds Interlace Fingers Clean Nails Against Palms Rinse with Fingertips Downward Dry with Paper Towels Turn off Faucet with Towel

Asepsis Freedom from Organisms Medical Asepsis Surgical Asepsis Clean Technique Surgical Asepsis Sterile Technique

Infection Prevention Standard Precautions Assume All Patients Infectious Blood, Body Fluids, Body Substances Hand Hygiene, Gloves, Gowns, Masks, Goggles, Face Shields

Infection Prevention (cont’d) Transmission-based Precautions Specific Communicable Diseases Used with Standard Precautions

Example: Vancomycin-Resistant Enterococci

Respiratory Tract Infection Prevention Risk Factors Invasive Tubes Prevention Oral Hygiene Coughing and Deep Breathing Ventilator-associated Pneumonia Bundles

Genitourinary Tract Infection Risk Factors Urinary Catheters

Genitourinary Tract Infection Prevention Appropriate Use of Urinary Catheters Intermittent Catheterization Strict Aseptic Technique Secure Tubing to Leg Closed System Drainage Bag Below Bladder Level

Surgical Wound Infection Prevention Sterile Technique for Dressing Changes Monitor Wound

Septicemia Prevention Sterile Technique for Catheters Uncontaminated Solutions Report Indications Promptly

Septicemia Indications Fever Tachypnea Tachycardia Hypotension Elevated White Blood Cell Count

Septicemia Treatment Blood Cultures Antibiotics IV Drotrecogin alfa (Xigris) Severe Sepsis

Antibiotic-Resistant Infections Methicillin-resistant Staphylococcus aureus (MRSA) Difficult to Treat High Mortality Rate Treatment: Vancomycin Hydrochloride

Antibiotic-Resistant Infections (cont’d) Vancomycin-resistant Enterococci (VRE) Difficult to Treat Combination Antibiotic Therapy Treatment Quinupristin/Dalfopristin (Synercid) Linezolid (Zyvox)

Treatment of Infectious Diseases Type of Organism Guides Drug Selection Antibiotics: Bacterial Infections Antivirals: Viral Infections Antifungals: Fungal Infections

Nursing Responsibilities Check Allergies Monitor Side Effects Signs of Superinfection

Patient Education Take All Medication Report Side Effects

Nursing Diagnoses Risk for Infection Acute Pain Imbalanced Nutrition Ineffective Protection Deficient Knowledge

Respiratory Tract Infections Assessment Signs and Symptoms Sputum Culture Nursing Diagnosis Risk for Infection

Gastrointestinal Tract Infections Assessment Signs and Symptoms Dehydration Stool Culture Nursing Diagnosis Risk for Infection

Genitourinary Tract Infections Assessment Signs and Symptoms Urinalysis Urine Culture Nursing Diagnosis Risk for Infection