MSALI: INFECTIONS

Terms ■Pathogens ■Host ■Colonization ■Reservoir ■Causative Agents ■Bacteria ■Aerobic ■Anaerobic ■Mode of Transmission ■Portal of Entry ■Portal of Exit ■Fungi ■Virus ■Protozoa ■Helminths ■Prions ■Human Body’s Defense Mechanisms ■Sepsis

Infection Control in Health-Care Agencies ■Community-acquired Infection ■Nosocomial Infection or Hospital – Acquired (HAI) ■Hand Hygiene

Nosocomial Infections ■Medicare implemented a policy on October 1, 2008 that penalizes hospitals if Medicare patients acquire any of 8 conditions during their inpatient stay ■3 of these conditions are infections: ■Catheter-Associated Urinary Tract Infection (UTI) ■Vascular Catheter-Associated Infection ■Surgical Site Infections, various

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

Local vs. Systemic Infections ■Local ■Pain, redness, swelling, warmth at site ■Systemic ■Headache, malaise, fever, anorexia, aches. ■Can progress to hypotension, tachycardia, mental confusion

Gram Positive Bacteria

Medications to Treat Infectious Diseases ■Table 8.3 ■Nursing responsibilities: ■Note all patient allergies ■Obtain culture samples before initiating antibiotic treatment ■Monitor and report all side effects ■Observe for s/s of superinfections

Antibiotic Resistant Infections

Who Is At Risk? ■Severe and/or prolonged illness ■Persons with comorbidities – especially chronic renal disease, diabetes mellitus, peripheral vascular disease, skin lesions ■Previous exposure to antimicrobial agents ■Invasive procedures – such as dialysis, invasive devices, urinary cauterization, surgery ■Repeated contact with HC system ■Previous colonization of MDRO ■Advanced Age

MRSA ■Methicillin Resistant staphylococcus aureus ■- a bacteria ■Common sites : –Nares –Skin Colonized

Treatment ■I & D ■Contact ISO Precautions ■Clindamycin ■Tetracyclines ■Rifampin ■Linezolid ■Bactrim ■Mupirocin ointment for topical tx

Prevention ■Hand Hygiene ■Decolonization

Decolonization ■Mupirocin ointment for nares ■Use of daily chlorhexidine baths in ICU ■populations may decrease overall rates of ■bloodstream infections and MRSA ■acquisition, but effect on MRSA infections ■less clear

VRE ■Vancomycin-resistant Enterococci ■- a bacteria ■normally present in the human intestines and in the female genital tract and are often found in the environment.

What types of infections does VRE cause? ■It can cause infections of the urinary tract, the bloodstream, or of wounds associated with catheters or surgical procedures.

Who is at RISK? ■People who have been previously treated with the antibiotic vancomycin or other antibiotics for long periods of time. ■People who are hospitalized, particularly when they receive antibiotic treatment for long periods of time. ■People with weakened immune systems. ■People who have undergone surgical procedures. ■People with medical devices that stay in for some time such as urinary catheters or central intravenous (IV) catheters. ■People who are colonized with VRE.

Treatment ■People who are colonized do not usually need treatment. ■Most VRE infections can be treated successfully with antibiotics other than vancomycin. ■Laboratory testing of the VRE sample can determine which antibiotics will successfully treat the infection.

Clostridium difficile Infection ■A spore-forming, Gram-positive anaerobic bacillus ■The bacteria are found in the feces. ■Associated with ABX use.

S/S of Clostridium difficile infection? ■watery diarrhea (at least three bowel movements per day for two or more days) ■fever ■loss of appetite ■nausea ■abdominal pain/tenderness

The risk for disease increases in patients with: ■antibiotic exposure ■proton pump inhibitors ■gastrointestinal surgery/manipulation ■long length of stay in healthcare settings ■a serious underlying illness ■Immuno-compromising conditions ■advanced age

Treatment ■The infection can usually be treated with an appropriate course of antibiotics, ■including metronidazole, vancomycin, or recently approved fidaxomicin. ■Fecal Transplant

■Contact Isolation - Healthcare workers and visitors must use gloves and gowns on entry to a room of a patient with CDI. ■Emphasize compliance with the practice of hand hygiene.

Community Acquired Infections ■An infection acquired outside health care settings, such as in the home or in the community.

Communicable Diseases ■See Handout

Influenza ■Influenza viruses are spread from person to person primarily through large-particle respiratory droplet transmission (e.g., when an infected person coughs or sneezes near a susceptible person).

■The typical incubation period for influenza is 1—4 days (average: 2 days) ■Most healthy adults may be able to infect others beginning 1 day before symptoms develop and up to 5 to 7 days after becoming sick

S/S ■fever, myalgia, headache, malaise, nonproductive cough, sore throat, and rhinitis

Occurrence

Diagnostics ■Preferred respiratory samples for influenza testing include nasopharyngeal or nasal swab, and nasal wash or aspirate, depending on which type of test is used. ■Samples should be collected within the first 4 days of illness. ■Rapid influenza diagnostic tests provide results within 20 minutes or less; viral culture provides results in 3-10 days

Prevention – FLU Vaccination – for residents and employees ■Flu vaccines cause antibodies to develop in the body about two weeks after vaccination. These antibodies provide protection against infection with the viruses that are in the vaccine. ■The seasonal flu vaccine protects against the influenza viruses that research indicates will be most common during the upcoming season.

Treatments ■Three antiviral drugs recommended by the CDC & approved by the FDA: oseltamivir (brand name Tamiflu®), zanamivir (brand name Relenza®) and peramivir (brand name Rapivab®). Tamiflu® comes as a pill or liquid, and Relenza® is an inhaled powder. (Relenza should NOT be used in anyone with breathing problems, like asthma or COPD, for example.) Rapivab® is administered intravenously.

Complications ■Dehydration ■Pneumonia ■Change in Mental status

Nursing Diagnoses ■Fluid Volume, deficient ■Activity Intolerance ■Risk for Injury ■Impaired Comfort ■Risk for Ineffective Breathing