1. Fundamental Nursing Skills and Concepts Chapter 22

2. INFECTIOUS DISEASES INFECTIOUS DISEASES are diseases spread from one person to another. They are also known as contagious( معدي ) or communicable diseases. Infectious diseases were once the leading cause of death. The threat of infectious diseases decreased because of vaccines, public health measures, and drug therapy. But, infectious diseases have not been eliminated. There are new, drug-resistant strains of TB, gonorrhea( السيلان ), and organisms which cause wound and respiratory infections. AIDS and SARS present grave threats to public health.

3. COLONIZATION DIFFERS FROM INFECTION COLONIZATION: A CONDITION IN WHICH MICROORGANISMS ARE PRESENT, BUT THE HOST DOES NOT MANIFEST ANY SIGNS OR SYMPTOMS OF INFECTION. INFECTION: A CONDITION THAT RESULTS WHEN MICROORGANISMS CAUSE INJURY TO A HOST. Whether infected or colonized, the host can transmit infectious diseases to others.

4. INFECTION CONTROL PRECAUTIONS INFECTION CONTROL PRECAUTIONS are physical measures designed to curtail the spread of infectious diseases. INFECTION CONTROL PRECAUTIONS interfere with the chain of infection and require knowledge of the mechanism by which an infectious disease is transmitted. Two major categories of infection control precautions are standard precautions and transmission-based precautions.

5. STANDARD PRECAUTIONS MEASURES FOR REDUCING THE RISK OF MICROORGANISM TRANSMISSION FROM BOTH RECOGNIZED AND UNRECOGNIZED SOURCES OF INFECTION. FOLLOW WHEN CARING FOR ALL CLIENTS, REGARDLESS OF DIAGNOSIS OR INFECTION STATUS. REDUCES THE POTENTIAL FOR TRANSMITTING BLOODBORNE PATHOGENS AND PATHOGENS FROM BODY FLUIDS. Follow whenever there is potential for contact with blood, body fluids, nonintact skin, or mucous membranes.

6. TRANSMISSION-BASED PRECAUTIONS Also called ISOLATION PRECAUTIONS. Three types: CONTACT PRECAUTIONS, DROPLET PRECAUTIONS, and AIRBORNE PRECAUTIONS. Used based on the mechanism of transmission of the pathogen. Used in combination if pathogen has multiple routes of transmission. Standard precautions are used with every patient, but transmission-based precautions may be discontinued depending on the pathogen.

7. CONTACT PRECAUTIONS MEASURES USED TO BLOCK THE TRANSMISSION OF PATHOGENS BY DIRECT OR INDIRECT CONTACT. Direct contact is skin-to-skin contact with an infected person. Indirect contact is contact with a contaminated object in the client’s environment. CONTACT PRECAUTIONS: Private room or room with a similarly infected client. Gloves. Gowns if drainage not contained by dressings or if excessive drainage like diarrhea. Equipment for client’s exclusive use. Used with drug resistant infections (whether skin, wound, respiratory, or GI), acute diarrhea, draining wounds or abscesses, and acute viral conjunctivitis.

8. DROPLET PRECAUTIONS MEASURES THAT BLOCK PATHOGENS WITHIN MOIST DROPLETS LARGER THAN 5 MICRONS. Pathogens carried on droplets exit the body during coughing, sneezing, or suctioning. Droplets do not remain suspended in the air and are encountered by close contact with the client (within 3 feet of the client). DROPLET PRECAUTIONS: Private room or room with similarly infected client. Standard precautions. Mask if within 3 feet of the client. Door may be open. Used with influenza, rubella( حصبة المانية ), streptococcal pneumonia( ذات الرئة ), and meningococcal meningitis.

9. AIRBORNE PRECAUTIONS MEASURES THAT REDUCE THE RISK OF TRANSMITTING AIRBORNE INFECTIOUS AGENTS WHICH ARE SMALLER THAN 5 MICRONS. Airborne pathogens are present in the residue( متبقي ) of evaporated droplets and remain suspended in the air and attached to dust particles. AIRBORNE PRECAUTIONS: Private room or room with a similarly infected client. Negative air pressure. Standard precautions. Mask. OSHA approved particulate air filter respirator if TB. Door closed. Used with pulmonary tuberculosis( سل ) and measles( حصبة ) (rubeola).

10. INFECTION CONTROL MEASURES PRIVATE ROOM SIGNS NOTIFYING VISITORS AND STAFF OF ISOLATION DISPOSABLE EQUIPMENT PERSONAL PROTECTIVE EQUIPMENT: Garments( ثوب ) that block the transfer of pathogens (gloves, cover gowns, masks, face shields, goggles). HOUSEKEEPING PRACTICES and DISPOSAL OF WASTE which serve to prevent the spread of the pathogen.

11. PERSONAL PROTECTIVE EQUIPMENT EQUIPMENT IS USED ONCE. GLOVES, GOWNS, AND MASKS ARE DISPOSED OF AFTER USE. CLOTH GOWNS ARE PLACED WITH SOILED LINEN AND CLEANED. THE MOST CONTAMINATED GARMENT( ثوب ) IS REMOVED FIRST. HANDS ARE THOROUGHLY WASHED AFTER REMOVING ALL PERSONAL PROTECTIVE EQUIPMENT AND BEFORE LEAVING THE CLIENT’S ROOM.

12. DISPOSAL OF CONTAMINATED ITEMS STURDY( قوي ), LINED CONTAINERS FOR SOILED LINEN AND TRASH IN THE ROOM. EMPTIED( تفرغ ) AT THE END OF EACH SHIFT OR SOONER IF FULL. EMPTIED USING DOUBLE-BAGGING WHERE THE BAG CONTAINING THE CONTAMINATED ITEMS IS PLACED WITHIN AN OUTER, CLEAN BAG. DISPOSABLE EQUIPMENT IS PREFERRED. REUSABLE ITEMS MUST BE PROPERLY CLEANED BEFORE REUSE. LAB SPECIMENS ARE TAKEN TO THE LAB IN SEALED CONTAINERS IN PLASTIC BIOHAZARD BAGS.

13. TRANSPORTING CLIENTS ON ISOLATION Client remains in private room unless absolutely necessary. Wheelchair or stretcher covered with sheet. Client also covered with sheet or blanket. CONTACT PRECAUTIONS: Client wears gown. Areas of drainage well-covered (for example, extra dressing over draining wound). DROPLET OR AIRBORNE PRECAUTIONS: Client wears mask. Inform receiving department of isolation. Staff in receiving department wear personal protective equipment. Limit time in receiving department.

14. NURSING CONSIDERATIONS Teach reasons for precautions to client and visitors. Assist visitors to follow precautions. Teach the client and significant others about the disease process, prevention of transmission, and any prescribed medications. Provide appropriate interaction with the client to mitigate the effects of sensory deprivation and decrease feelings of social isolation.

15. THE ELDERLY AND INFECTIOUS DISEASES Older adults have a decreased immune response. Chronic diseases make it harder to resist infections. Symptoms of infection will be more subtle. A change in behavior or mental status may indicate an infection. Older adults may have a lower baseline temperature. A “normal” temperature may actually indicate an infection. Early detection and prompt( يحث ) treatment can prevent hospitalization. Infection is major reason for transfer from nursing home to hospital.