Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

Pathogen—microorganism capable of producing disease Communicable—infection transmitted from person to person Pathogenicity—ability to cause disease Virulence—degree of communicability

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Normal flora—characteristic bacteria of a body location; often competes with other microorganisms to prevent infections Colonization—microorganism present in tissue but not yet causing symptomatic disease Surveillance—tracking and reporting of infections

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Reservoir Pathogen Toxin Exotoxin Endotoxin Host defenses: Susceptibility

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Resistance to infection usually associated with presence of antibodies or cells acting on specific microorganisms

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Passive immunity—of short duration, either naturally by placental transfer or artificially by injection of antibodies Active immunity—lasts for years, occurs naturally by infection or artificially by stimulation (vaccine) of immune defenses

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Respiratory tract GI tract Genitourinary tract Skin/mucous membranes Bloodstream

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Contact—direct or indirect Droplet—e.g., influenza Airborne—e.g., tuberculosis Vector-borne—e.g., insects/animals (Lyme disease) Contaminated food/water Portal of exit

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Body tissues Phagocytosis Inflammation Immune systems Antibody-mediated Cell-mediated

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. HAI acquired in inpatient setting; not present at admission Endogenous infection—from patient flora Exogenous infection—from outside the patient, often health care workers’ hands

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Practice hand hygiene, proper handwashing Personal protective equipment (PPE)

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

Adequate staffing Sterilization Disinfection Patient placement Cohorting Patient transportation

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Standard Precautions Respiratory hygiene/cough etiquette (RH/CE) Patient, staff, and visitor education Posted signs Hand hygiene Cover nose/mouth with tissue Safe infection practices Safe injection practices

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Airborne Precautions Droplet Precautions Contact Precautions

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Negative airflow rooms required to prevent spread of microbes HEPA filter For TB, measles, chickenpox

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. For droplet transmission route Protect from droplets that may travel 3 feet but are not suspended for long periods For influenza, mumps, pertussis, meningitis

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. For known or suspected infections transmitted by direct contact or contact with items in environment For MRSA, pediculosis, scabies, RSV, C. difficile

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Vancomycin Linezolid Community-associated MRSA Health teaching best way to decrease incidence

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Healthy non-hospitalized people infected Health teaching best way to decrease incidence Perform frequent hand hygiene, including use of hand sanitizers Avoid close contact with people with infectious wounds Avoid large crowds Avoid contaminated surfaces Use good overall hygiene

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Vancomycin-resistant Enterococcus (VRE) Multidrug-resistant tuberculosis Gonorrhea Vancomycin-intermediate Staphylococcus aureus (VISA) Vancomycin-resistant S. aureus (VRSA)

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. “Slimy,” very hard to treat Antimicrobial catheters (silver alloy or antimicrobial coating) recommended to decrease encrustation

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Noncompliance/nonadherence Legal sanctions compelling a patient to complete treatment (e.g., TB) Septicemia Septic shock

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Normal bacteria that live in intestinal tract; important for digestion Cause infection outside GI tract Can live on almost any surface

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. History Physical assessment and clinical manifestations Psychosocial assessment

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Laboratory assessment: Culture and antibiotic sensitivity CBC ESR Serologic testing Imaging

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Home care management Teaching for self-management Health care resources

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. A 27-year-old patient is admitted from the ED to the med- surg unit with cellulitis of the left leg. A culture result from her primary care provider’s office indicated she was positive for MRSA in the leg wound. Based on this information provided during the SBAR report, what type of isolation room should the nurse prepare for the patient when she arrives on the unit?

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. After the patient is settled in her room, what special precautions does the nurse implement based on her diagnosis? (Select all that apply.) A. Wear gloves when entering the room. B. Wear a mask when working within 3 feet of the patient. C. Wear a gown to prevent contact with contaminated items. D. Keep the door closed at all times. E. Dedicated equipment should be used for this patient alone.

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. An hour later, the nurse is preparing to administer the patient’s medications. Which drug was likely ordered by the provider to combat the patient’s MRSA? A. Amoxicillin (Amoxil) B. Ciprofloxacin (Cipro) C. Erythromycin (Erythrocin) D. Vancomycin (Vancocin)

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. After lunch, the patient asks how she could have contracted the MRSA infection. What is the nurse’s best response? A. “Some people who travel to third-world countries return with this infection.” B. “The most common way for MRSA to spread is through coughing illnesses such as flu.” C. “ MRSA is spread by direct contact in hospitals and communities.” D. “In the community, MRSA is transmitted by the airborne route carried by droplets.”

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 32

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Cleansing hands with an alcohol-based hand rub is appropriate in which situation? A. After administering medications to a patient B. After working with a patient who has diarrhea due to Clostridium difficile C. After using the bathroom D. To cleanse visibly soiled or sticky hands

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Which person is at greatest risk of infection? A. 36-year-old prescribed a 10-day steroid tapper B. 64-year-old with history of prostate hyperplasia C. 24-year-old with chronic kidney disease D. 37-year-old pregnant woman

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. What health care acquired infection (HAI) occurs most frequently? A. Surgical site infection (SSI) B. Catheter-associated urinary tract infection (CA-UTI) C. Catheter-related bloodstream infection (CR-BSI) D. Pneumonia