1. Care of Patients with Infection
Chapter 25
Care of Patients with Infection

2. Definitions Pathogen—any microorganism capable of producing disease
Communicable—infection transmitted from person to person
Pathogenicity—the ability to cause disease
Virulence—the degree of communicability

3. Definitions (Cont’d)
Normal flora—characteristic bacteria of a body location; it often competes with other microorganisms to prevent infections
Colonization—the microorganism present in tissue but not yet causing symptomatic disease
Surveillance—the tracking and reporting of infections

4. Overview of Chain of Infection
Reservoirs
Pathogens:
Toxins
Exotoxins
Endotoxins
Host Defenses:
Susceptibility

5. Immunity
Resistance to infection is usually associated with the presence of antibodies or cells acting on specific microorganisms.

6. Immunity (Cont’d)
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.

7. Antibodies

8. Antibodies Mechanism of Action

9. Portal of Entry Sites Respiratory tract GI tract Genitourinary tract
Skin/mucous membranes
Bloodstream

10. Mode of Transmission
Contact transmission by direct or indirect contact
Droplet transmission such as in influenza
Airborne transmission such as in tuberculosis
Contaminated food or water
Vector-borne transmission involving insect or animal carriers, such as in Lyme disease
Portal of exit

11. Physiologic Defenses Against Infection
Body tissues
Phagocytosis
Inflammation
Immune systems:
Antibody-mediated immune system
Cell-mediated immunity

12. Infection Control in Inpatient Health Care Agencies
Health care–associated Infection (HAI) is acquired in the inpatient setting; not present at admission.
Endogenous infection is from a patient’s flora.
Exogenous infection is from outside the patient, often from the hands of health care workers.

13. Methods of Infection Control
Practice hand hygiene and proper handwashing.
Personal protective equipment (PPE).

14. Nurse in Personal Protective Equipment Caring for Patient in Protective Isolation Room

15. Infection Control Adequate staffing Sterilization Disinfection
Patient placement:
Cohorting
Patient transportation

16. CDC and Prevention Transmission–Based Guidelines
Standard Precautions:
Respiratory hygiene/cough etiquette (RH/CE)
Safe injection practices

17. Transmission-Based Precautions
Airborne Precautions
Droplet Precautions
Contact Precautions

18. Methicillin-Resistant Staphylococcus Aureus (MRSA)
Vancomycin
Linezolid
Community-associated MRSA
The best way to decrease the incidence of this growing problem is health teaching

19. Other MDROs Vancomycin-resistant Enterococcus (VRE)
Multidrug resistant tuberculosis
Gonorrhea
Vancomycin-intermediate Staphylococcus aureus (VISA)
Vancomycin-resistant S. aureus (VRSA)

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

21. Collaborative Care History
Physical assessment and clinical manifestations
Psychosocial assessment

22. Collaborative Care (Cont’d)
Laboratory assessment including:
Culture and antibiotic sensitivity testing
Complete blood count
Erythrocyte sedimentation rate
Serologic testing
Imaging assessment

23. Community-Based Care Home care management Health teaching
Health care resources