1. Susan Fowler sfowler@tricountycc.edu
Infection P & P Chapter 34
Susan Fowler
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Objectives (pp.4-6)
We will be combining the objectives from the Infection and Inflammation Concepts.
The Infection Concept is presented in this lecture. MRSA, Cellulitis, and UTI are the exemplars for the Infection Concept and are in a separate lecture.
The Inflammation Concept and its exemplar, appendicitis, is a separate lecture.
Please look in the Infection Control folder for additional useful information.
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Nature of Infection
Infection—disease state resulting from the presence of pathogens in the body. May be acute or chronic
Pathogens—disease-producing microorganisms—bacteria, viruses, fungi, parasites (643). The presence of these pathogens usually produces an inflammatory response.
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Course of Infection (646)
Incubation period—time between entry of pathogen and onset of sx
Prodromal stage—nonspecific sx, most infectious
Illness stage—worst sx
Convalescence—recovery time
Length of each stage depends on type of infection—may be local or systemic
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5. Chain or Cycle of Infection (642)
Infectious agent (pathogen)
Reservoir (place it lives)
Portal of exit (orifices or breaks)
Mode of transmission (how it moves)
Portal of entry (orifices or breaks)
Susceptible host (stressors)
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6. Infectious Agent (Pathogen)
Depends on warmth, darkness, food, water, moisture, presence or absence of O2, proper pH. Some can produce spores when conditions are not favorable. Some mutate in order to survive.
Number and ability to reproduce
Virulence—hardiness and invasiveness
Entry and survival in host—have specificity
Susceptibility of host
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Reservoir
Human—mucous membranes of tracts, tissues, blood
Animal—same
Water
Soil
Air
Fomites
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8. Modes of Transmission (645)
Contact:
Direct—person to person
Indirect—person to object
Droplet—traveling particles
Air: coughing, sneezing, dirt particles
Vehicles: water, blood, food, items
Vectors: flies, ticks, mosquitos, fleas, lice
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9. Defenses Against Infection
Normal body flora
Body system defenses—647
Inflammatory response
Vascular and cellular responses
Formation of exudates
Tissue repair
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The Susceptible Host
Changes in normal body flora
Breakdown in body systems
Flawed inflammatory response
Problems with tissue repair
Stressors
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11. Nosocomial Infections (HAIs)
Latin for “hospital acquired” Now called “health care associated infections”
Approx 2 million/yr; $4.5 million; 11th leading cause of death in U.S.
Top infections—648
Iatrogenic—caused by procedure
Exogenous—external or outside body
Endogenous—internal or inside body
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12. How Do We Stop the Infection Cycle? Assessment
Status of body defenses (skin, resp, etc)
Client susceptibility (risk factors)
Clinical appearance—may be symptomatic or asymptomatic
Lab data
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13. Client Susceptibility
Age—see p. 649
Nutritional status—those with low protein levels; those who need more protein d/t illness state; those who cannot feed themselves or can’t swallow
Stress—resistance is lower
Diseases that impair the body defenses and immunity
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Clinical Appearance
Localized
Warmth
Swelling
Redness
Drainage
Pain/tenderness
Restricted movement
Systemic
Changes in VS
Fatigue
N/V/D
Malaise
Lymphadenopathy
Confusion
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Laboratory Data (651)
WBC (Totals and differentials) Amount elevated usually indicates severity. “Left shift” usually indicates a severe infection.
ESR—Non-specific inflammatory marker
Fe—low in chronic infection
+Cultures and gram stains
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16. Pertinent Nursing Diagnoses
Infection
Skin integrity
Incontinence
Imbalanced nutrition
Self-care deficit
Impaired oral mucous membrane
Social isolation
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17. Expected Outcomes—What Do We Want Clients to Achieve?
Client will be free of infection
Exposure to infection will be reduced
Client will receive care that will eliminate existing infection
Client/family understand S/S of infection
Client/family understand how to reduce risk of infection
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Interventions
Protect clients (662)
Educate clients (669)
Maintain own worker health
Give antimicrobials
Be aware of S&S of infection
Practice medical and surgical asepsis
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Medical Asepsis
Practices designed to reduce the # & transfer of pathogens. A.K.A. “clean technique”
Handwashing
Cleaning and disinfecting surfaces
Applying clean dressings
Applying Standard Precautions (663)
Observing transmission-based precautions (663)
Utilizing isolation procedures
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Surgical Asepsis
Practices designed to render & keep objects & areas free from microorganisms. A.K.A. “sterile technique.” Principles p. 669
Sterile procedures
Opening and maintaining a sterile field
Sterile scrub
Surgical skin prep
Gowning/gloving
Sterilization of surfaces
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Evaluating Outcomes
How do you know client is free from infection?
How do you know exposure has been reduced?
How do you know if client received treatment?
How do you know if client/family understand?
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22. Who is Responsible for Controlling Infection?
Center for Disease Control (CDC)
Occupational Health and Safety Organization (OSHA)
Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
Infection Control Professional
Anyone who comes in contact with patients!
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23. Noteworthy Precautions
Although it is allowed by CDC and JCAHO, keep in mind that the following require extra care to prevent the spread of pathogens:
Medical and surgical patients not being separated
Peds patients with adult patients
Patients with drains in same room as infectious patients
Lack of private baths
Nurses caring for both infectious and noninfectious patients
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