Interventions for Clients with Infection

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-borneVector-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

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

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

Definitions  Pathogen is any disease- producing microorganism.  Communicable is via person-to- person contact.  Pathogenicity is the ability to cause disease.  Virulence is the degree of communicability. (Continued)

Definitions (Continued)  Normal flora often competes with microorganisms to prevent infections.  Colonization is the microorganism present in tissue, but not yet causing symptomatic disease.

Overview of Chain of Infection  Reservoirs  Pathogens –Toxins –Exotoxins –Endotoxins

Immunity  Resistance to infection is usually associated with the presence of antibodies or cells acting on specific microorganisms. (Continued)

Immunity (Continued)  Passive immunity is of short duration, either naturally by placental transfer or artificially by injection of antibodies.  Active immunity lasts for years and occurs naturally by infection or artificially by stimulation (vaccine) of immune defenses.

Portal of Entry Sites  Respiratory tract  Gastrointestinal tract  Genitourinary tract  Skin/mucous membranes  Bloodstream

Mode of Transmission  Contact transmission by direct or indirect contact  Droplet transmission such as in influenza  Airborne transmission such as in tuberculosis  Vector-borne transmission involving insect or animal carriers, such as in Lyme disease

Physiologic Defenses Against Infection  Body tissues  Phagocytosis  Inflammation  Specific defenses –Antibody-mediated immune system –Cell-mediated immunity

Infection Control in Inpatient Health Care Agencies  Nosocomial or health care– associated infections are infections acquired in the inpatient health care setting which were not present or incubating at admission.  Endogenous infection is from a client’s flora.  Exogenous infection is from outside the client, often from the hands of health care workers.

Methods of Infection Control  Practice hand hygiene and proper hand washing.  Artificial fingernails create poor hand hygiene.  Gloves should be worn.  The CDC provides guidelines for disinfection and sterilization, outlining standard precautions for all modes of transmission.

Multiple Drug–Resistant Infections  Multiple drug–resistant infections are no more transmissible than their drug- sensitive counterparts, S. aureus and Enterococcus organisms.  To control antimicrobial resistance in health care settings, see the CDC program.

Problems from Inadequate Antimicrobial Therapy  Noncompliance or nonadherence  Legal sanctions that compel a client to complete treatment, such as in the instance of tuberculosis  Septicemia  Septic shock

Collaborative Management  History  Physical assessment and clinical manifestations  Psychosocial assessment (Continued) (Continued)

Collaborative Management (Continued)  Laboratory assessment including: –Culture and antibiotic sensitivity testing –Complete blood count –Erythrocyte sedimentation rate –Serologic testing –Radiographic and other assessment

Hyperthermia Interventions  Eliminate the underlying cause of hyperthermia and destroy the causative microorganism.  Manage fever by: –Drug therapy: antimicrobial, antipyretic therapy –External cooling, fluid administration, and fans

Risk of Social Isolation  Interventions include: –Education about the mode of transmission of infection and mechanisms that spread it –Assess coping mechanisms used in the past. –Maintain communication with the client.

Health Teaching  Education on these topics is vital to client’s understanding of transmission prevention precautions: –Infection control –Drug therapy –Psychosocial support –Health care resources