Infection Control “A bad cold wouldn’t be so annoying if it weren’t for the advice of our friends.” Kin Hubbard

Abbreviations CDC – Centers for Disease Control AIDS – Acquired Immunodeficiency Virus CBC – Complete Blood Count C&S – Culture and Sensitivity HIV – Human Immunodeficiency Virus PEP – Post Exposure Protocol

Asepsis Medical – includes all practices intended to confine a specific microorganism to a specific area, limiting number, growth & transmission – clean vs. dirty Surgical Asepsis – sterile technique – practices to keep an area free from all microorganisms

Types of Infection Local Systemic Acute Chronic

Nosocomial Infections Infections that are associated with the delivery of health care services in a health care facility Point of origin 1. Endogenous 2. Exogenous 3. Iatrogenic

Risks for Nosocomial Infection Poor hand washing Compromised host – surgery/illness Improper procedure technique – dressing, suctioning, catherization Improper cleaning/maintenance of invasive devices – foley catheter, IV line Contamination of closed drainage system – chest tubes

Chain of Infection Etiologic Agent Reservoir Portal of Exit from Reservoir Method of Transmission Portal of Entry into Susceptible Host Susceptible Host

Etiologic Agents Bacteria Viruses Fungi Parasites Resident Transient

Reservoir Environmental Human Animal/Insect

Portal of Exit from Reservoir Mouth, nose Urinary tract Wounds Device insertion sites Other orifices

Method of Transmission Direct Indirect Vehicle-borne Vector-borne Airborne

Factors Increasing Susceptibility to Infection Age Heredity Level of stress Nutritional status Medications Illness – acute/chronic

Body Defenses Against Infection Anatomic & Physiologic Barriers Inflammatory Response Antibody-Mediated Defenses Cell-Mediated Defenses

Inflammatory Response Five Signs: 1. Pain 2. Swelling 3. Redness 4. Heat 5. Impaired Function Three Stages: 1. Vascular and cellular responses 2. Exudate production 3. Reparative phase

Antibody-Mediated Defenses Active Infectious microorganisms Vaccines Passive (Acquired) Natural – breast milk Artificial – immune serum

Cell-Mediated Defenses T-cell system – exposure to antigen causes release into lymph system 1. Helper 2. Cytotoxic 3. Suppressor

Course of Infection Incubation period – time between initial contact and appearance of symptoms Prodromal stage – time from onset of nonspecific symptoms to more specific symptoms – transmission possible

Course of Infection Full/Illness stage – time that specific symptoms present – acute – transmission possible Convalescence – time when symptoms resolve and host returns to pre-illness state

Laboratory Tests 1. White blood cell count – Leukocyte – nonspecific unless differential done to break down types of WBC’s – normal 4,500 – 11, Erythrocyte sedimentation rate – ESR – increased rate of RBC’s settling in presence of inflammatory process 3. Culture & Sensitivity – C&S urine, blood, sputum, wound – determines organism and effective medication

Nursing Diagnosis Risk for Infection – PRIMARY Potential Complications of Infection Impaired Physical Mobility Imbalanced Nutrition Acute Pain Impaired Social Interaction/Social Isolation Situational Low Self-Esteem Anxiety

Breaking the Chain of Infection Host Reservoir Portal of Exit Transmission Portal of Entry

Interventions to Reduce Risk of Infection Preventing Nosocomial Infections: 1. Hand washing 2. Proper technique 3. Environmental controls 4. Management of clients at risk

Interventions to Reduce Risk of Infection Supporting Defenses of Susceptible Host: 1. Hygiene 5. Immunizations 2. Nutrition 6. Stress 3. Fluid 4. Rest and sleep

Interventions to Reduce Risk of Infection Cleaning, Disinfecting, Sterilizing 1. Cleaning inhibits growth of microorganisms 2. Disinfecting with chemicals – bacteriostatic vs. bactericidial 3. Sterilizing – destroys all microorganisms – including spores/viruses – moist heat, gas, boiling water, radiation

CDC Isolation Guidelines Tier One Standard Precautions Tier Two – Transmission Based Precautions Airborne Droplet Contact

Standard Precautions All clients Apply blood, body fluids, excretions/secretions, non-intact skin, mucous membranes Designed to reduce risk of transmission from all sources

Airborne Precautions Infections spread through air – TB, varicella, rubeola Private room – negative air pressure/air exchange Door closed Respiratory equipment Mask client in transport

Droplet Precautions Large particle droplet infections – rubella, mumps, scarlet fever, some pneumonias Private room or cohort Respiratory protective equipment – within 3 feet of client Transport client with mask

Contact Precautions Infections spread by direct/indirect contact – wound infections, scabies, antibiotic resistant infections – MRSA, VRE Private room or cohort Gloves entering room – wash hands in room Personal protective equipment when in direct contact with infected body secretions Limit movement client outside of room

Protective Isolation Protects clients with compromised immune systems Private room Protective garb worn in room – gloves, gown, mask – may vary with facility No fresh fruits, vegetables, flowers Client mask outside of room

Guidelines for Exposure to Bloodborne Pathogens Report – verbal, written Seek appropriate evaluation and follow- up Puncture/laceration Mucous membrane exposure Post exposure protocols – PEP – HIV and hepatitis B & C