Infection/Inflammation,

What is the primary task a nurse can perform to prevent the spread of infections? 1.Wash hands for 30 seconds 2.Wear a mask 3.Wear gloves 4.Sneeze into his hand.

INFECTION A disease state caused by the invasion and multiplication of a pathogen, a disease- producing microorganism, in body tissues. Pathogens – bacteria, viruses, fungi or parasites The body responds to the invasion by forming antibodies and a series of physiological changes

common organisms with antimicrobial resistance Methicillen Resistant Staphylococcus aureus (MRSA), Methicillen Resistant Staphylococcus epidermis (MRSE), Vancomycin Resistant Enterococcus faecium (VRE)

COURSE OF INFECTION Clinical course of infection – period when it can be transmitted to others. Clinical course of an infection varies: – Causative organism – Dose and virulence of the causative organism – Mode of entry of the organism – Site of infection – Overall host resistance (health status) of the infected person

4-PHASES OF AN INFECTION INCUB ATION PERIOD – exposure to first symptom – Depending on the disease it can be transmitted – Incubation period varies – Knowing the incubation period may be helpful...why?

4-PHASES CONT. PRODROMAL PHASE – is a period of vague, nonspecific symptoms that may precede the full manifestation of some infections. – Symptoms may include: malaise, low-grade fever, nausea, weakness, general aches

4 – PHASES CONT. CLINICAL ILLNESS PHASE – symptoms are fully manifested and clearly recognized as representing a specific infection. – Diagnosis – signs and symptoms and confirmed after obtaining cultures to identify the specific organism.

4-PHASES CONT. CONVALESCENCE PHASE – is the time following the acute symptoms to the time of normal health – Decreased energy and feeling tired

Phagocytosis – WBCs detect an intruder then go to eliminate them. The WBC track and pursue the invader. Phagocytic WBCs coat the intruder with sticky substances and extend pseudopods (footlike extensions) to engulf them. Enzymes within the phagocytic WBC help digest and neutralize them. Some debris may leak from the WBC into the extracellular fluid. This WBC migration, phagocytosis, and leakage all contribute to inflammation

Physiology of the inflammatory Process Injury >releases substances from damaged cells> capillary dilatation> increased capillary permeability> fluid with infection-fighting proteins escape from wall of the capillaries> proteins release factors that attract phagocytic cells that engulf or destroy invading microorganisms> white and red blood cells are also in the fluid, white blood cells of various types (leukocytes, macrophages, granulocytes, and null cells) fight infections

INFLAMMATION INFLAMMATION - A basic way in which the body reacts to infection, irritation or other injury, the key feature being redness, warmth, swelling and pain. Inflammation is now recognized as a type of nonspecific immune responseinfectionpainimmune response

INFLAMMATION INFLAMMATORY RESPONSE – Second line of defense against infection – Localized reaction to injury – Activated when tissue damage occurs – Responds to invasion by microorganisms – Very complex – enormous flexibility and effectiveness

ACUTE INFLAMMATION Acute Inflammation is the short-term immune response our bodies mount in cases of trauma, infection, and allergy.

CHRONIC INFLAMMATION Chronic inflammation arises when this response is not completely turned off or extinguished. It acts like a slow-burning fire, continuing to stimulate pro-inflammatory immune cells when they may not be needed. – Six months generally used to characterize “chronic.”

NOSOCOMIAL vs. IATROGENIC INFECTIONS Nosocomial Infection – Hospital-acquired -3 days – Was not present or incubating at the time of admission – 5-10% of patients – Multiple resistant organisms infect 25% Iatrogenic Infection – The direct result of treatments such as invasive procedures

DEFENSES AGAINST INFECTION Primary – Skin – Mucous membranes – Respiratory tract – GI tract – GU tract Secondary – The immune and inflammatory responses constitute the second line of defense against infection

CHAIN OF INFECTION Each link represents a component Each link must be present and in sequential order for an infection to occur. The links are: – infectious agent – reservoir – portal of exit from the reservoir – mode of transmission – portal of entry into a susceptible host.

DIAGNOSTIC TEST WBC – The total WBC count reflects the body’s response to infection. Neutrophils50-70% – Segs50-70% – Bands0-8% Eosinophils1-4% Basophils0.4-1% Monocytes2-6% Lymphocytes20-40%

Diagnostic Tests Culture – Determines actual organism causing infection Gram Stain – Is a specific microscopic test used to obtain rapid results on a sample ESR – Erythrocyte Sedimentation Rate (ESR) is also called Sed Rate or Sedimentation Rate. It is a simple test used to determine how much inflammation is in the body, but it cannot diagnose the specific condition causing the inflammation.

DIAGNOSTIC TESTS Antigen – is a substance capable of inducing a specific immune response. The term is derived from the (gen) (eration) of (anti) (bodies) to such substances. Specific immune responses require recognition molecules like the T cell receptor or antibodies which recognize the antigen, or parts of it, and stimulate a response by the specific arm of the immune response (T or B cells).

DIAGNOSTIC TESTS C-reactive Protein – Nonspecific test used to diagnose bacterial infections, inflammation, and necrosis – CRP is more sensitive and responds more rapidly than the ESR – Increase CRP may predict coronary events

ASSESSMENT OF PATIENT FOR INFECTION Health History – Questions r/t immunization – Exposure to communicable disease – Current and past illness – Travel history – General health status Physical Examination – Localized & Systemic

NURSING DIAGNOSIS Risk for Infection Ineffective Protection Anxiety/Fear Impaired Social Interaction

NURSING INTERVENTIONS Standard Precautions – CDC Tier 1 – Gloves (preferably non-latex). – Water-impermeable gowns – Masks or respirators – Eye protection Transmission-Based Precautions –CDC Tier 2 – Airborne – Droplet – Contact

NURSING INTERVENTIONS Medical Asepsis – Prevention Hand Hygiene Environmental Controls Disposing of Bodily Wastes

INTERVENTIONS Select nursing interventions related to: – Drug Therapy Antipyretics(acetaminophen, aspirin) Antiinflammatory (salicylates, corticosteriods) – Diet Therapy Fluids General Nutrition Vitamins

INTERVENTIONS Patient Teaching Risk for infection and altered protection Protection of the immune compromised patient Infection Prevention