1. Infection Control Barriers to Health  Locus of control  Internal Locus: self-directed, researches and maintains present health  External Locus: Others must do what they can to treat or teach the person to be healthy.

2. Healthy People Healthy People 2000 & 2010 are goals for health set forth by committee and the Surgeon General of the United States. Recommendations for 2010: 1. increase quality and years of healthy life 2. eliminate health disparities

3. Identification Treatment & Superbugs A culture and sensitivity must be done prior to treatment. If the organism is sensitive to an antibiotic, it is administered to eradicate the infection. The med should be chosen that is sensitive and the least expensive. Another consideration is the strength of the anti- infective. Use lesser agents if effective, not the super- broad spectrum preparations. (Help prevent resistance)

4. Infection Process Agent Environment Host

5. Infectious Process Agent Environment Host

6. The Chain of Infection Transmission

7. Organisms Prions Viruses Bacteria  Cocci  Bacillus  Spirochetes Mycoplasmas Rickettsiae, Chlamydiae, Ehrilichieae and Coxiella Fungi Parasites

8. Agent Causative Agent- Humans co-exist with many micro- organisms in a mutually beneficial relationship. Many reside on or in the host and usually do not cause harm. Examples: E.Coli in the bowel Staph Aureus on the skin Fungus in the vaginal canal

9. Reservoir or Environment Transmission of an infectious agent from a source to a susceptible host occurs when the host comes into contact with a reservoir where organisms have lived and multiplied. Examples are infected people, plants, soil, food, etc. Infected people are the reservoirs for most bacteria and viruses that affect humans.

10. Routes of transmisson (May be more than one route) Contact Droplet Airborne Vehicle Vector

11. Host Some humans are more susceptible to infectious agents. Factors such as age, sex, ethnicity, heredity, socioeconomic status, general health, lifestyle (IV drug abuser, unsafe sex practices, ETOH abuse, sedentary lifestyle), nutritional integrity, pre-existing illness (diabetes), hygiene, and living conditions.

12. Precautions Standard Airborne Droplet Contact Strict contact

13. Latent Period of Infection The time during which the pathogen is replicating with no symptoms in the client, but the client is infectious.

14. Sub-Clinical Infection An asymptomatic response of the host to the pathogen. An asymptomatic host can still transmit a pathogen. The host may harbor the pathogen in sufficient quantities to shed it at any time after latency and toward the end of the incubation period. The time during which an organism can be shed is called the “period of communicability”  Example-Varicella.

15. Nosocomial Infections Occurs within 48-72 hours of admission to the health care facility. No incubation on admission. Increases morbidity which increases hospitalization cost Sources:  Health Care Workers  Clients  Liquids, Inanimate objects  HANDWASHING AND GOOD SANITARY HABITS HELP

16. Common Infection Sites Urinary Tract Infections  E. Coli, Klebsiella pneumoniae Pneumonia  Pseudomonas Aeruginosa Surgical Wound Infection  Endogenous  Exogenous Blood Stream  Staph aureas- becoming more prevalent with the use of central venous catheters.

17. Clostridium Difficile Cause- Overuse of antibiotics that disrupt the normal flora of the bowel Antibiotic resistant spores proliferate in the intestine and release toxins into the lumen of the bowel Pseudomembranous colitis Diagnosis Treatment What not to do Complications Remember

18. Methacillin-Resistant Staphlococcus Aureus MRSA has evolved over years of antibiotic use. Now community acquired forms of MRSA are becoming more and more prevalent. (CA-MRSA). Vancomycin-resistant staph aureus (VRSA) Treatment Uncertainty of colonization

19. Vancomycin-Resistant Enterococcus VRE- normal flora of the GI tract that produces significant disease when it infects blood, wounds or urine. Treatment Multi-drug resistant VRE

20. Immunity The 1 st line of defense –Physical  Intact skin  Mucous membranes  Oil and Perspiration on the skin  Cilia active and present in the respiratory passages (mucus pump.  Gag and cough reflexes  Peristalsis of the GI tract and gastric secretions  Flushing action of tears (lysozyme), saliva, and mucus.

21. Lines of Defense (continued) Second line of defense is the inflammatory process. Third line of defense is the immune system.  Cellular immunity-T cells –cell on cell activity  Humoral immunity-B-cells (AKA plasma cells)-antibodies

22. Preventing & Controlling Infections HANDWASHING- Hand sanitizer is an effective substitution for handwashing except for Clostridium difficle (very stubborn spore-former) Standard Precautions Education Immunizations (New-Rototeq, Gardisil) Proper use of personal protective equipment (PPE) Isolation precautions Housekeeping Practices OSHA regulations

23. Reducing Infectious Diseases Maximizing host defenses through vaccination. Active Vaccination  Modified infecting agent (vaccine or toxin) to stimulate the immune response.  Passive Vaccination-passive immunity by administering antibodies.

24. Regulatory Agencies & Vaccinations Measles, Mumps, Rubella (MMR)- 2 doses after 12 months of age Tuberculosis screening- On employment and annually. Varicella Hepatitis B- 3 doses

25. Infection Control Programs Minimize Nosocomial Infections  Surveillance  Reporting  Control  Prevention Barriers prevent the transfer of an infectious organism to the host There is no barrier that can substitute for handwashing!