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La Consolacion University Philippines

(formerly University of Regina Carmeli)
Graduate School Department

Name: Allan M. Manaloto, RN Professor: Dr. Amelia Sta. Maria
Subject: Advanced Pathophysiology Date: November 09, 2013

Learning Objectives:
I. Understand basic concepts of Infection.
II. Apply required knowledge in preventing and/or minimizing infection.
III. Perform appropriate behaviors required to prevent health care associated
IV. Demonstrate required competence to provide patients with safe care.
I. I N T R O D U C T I O N
Modern healthcare has shown great progress in preventing and treating
infectious diseases. In developed countries, they have sanitary (better) living
conditions, clean water, uncontaminated food, vaccinations, and antimicrobials.
Many microorganisms find human body to be hospitable site to grow and flourish,
provided with nutrients and appropriate temperature and humidity. In many cases,
a mutual relationship exists, in which humans and the microorganisms benefit. This
is maintained by inflammatory and immune systems. If this 2 compromised,
microorganisms leave their normal sites and cause infection.
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1. Innate Host (body) Resistance
a.) First line: External barriers (skin & mucous membrane)
b.) Second line: Inflammatory Response
c.) Third line: Immune System
2. Chain of Infection
Infections are spread through a process known as chain of infection.

a.) Causative Organism
there must 1
be a pathogen: bacteria, virus, fungi, and protozoa.
b.)Reservoir/ Source of the pathogen
term use for any person, plant, animal, substances, or location that
provides nourishment for M.O.
Nurse: Disinfect/ Sterilized equipments, and environmental sanitation.
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Living Reservoir
-Humans: most important reservoir
-Animals: Zoonotic dse-infectious disease that human acquired from
Non-Living Reservoir
-Air, soil, dust, food, fomites
c.) Portal of Exit
way for the pathogen to escape from reservoir. (eg. secretions, excretions,
skin, droplets).
Nurse: Hand Hygiene, Control excretion, Proper waste disposal.

d.) Mode of Transmission (MOT)
way for the pathogen to travel; Connect the infectious source to the new
specific organism requires specific route of transmission for infection to
Nurse: Hand hygiene, Standard precaution, Isolation, and food handling.

MOT is transported to host in ways:
- Direct skin-skin contact (ex. Handshaking)- most prevalent MOT
- Direct mucous mem (ex. Kissing/ Sexual intercourse)
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- Travels long distances (e.g. M. TB); most contagious airborne diseases
are caused by respiratory pathogens carried to susceptible people in
droplets of respiratory secretions. (ex. Colds, influenza, measles,
chicken pox)

-large particles enter the air and drop due to weight. Transmitted via
coughing/ sneezing . The infected pt must be near the host.

-usually not in hospital settings; various types of biting insects and
arachnids; They transfer pathogens from infected person to another (bites).

Vehicles/ Vehicular
-contaminated inanimate object- food, water, dust, fomites. (by secretion
urine,blood, feces, exudates)

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e.) Portal of Entry
- how the M.O enter to a susceptible hosts. Mucus mem, GIT, GUT, broken
- Nurse: Catheterization care, wound care, Aseptic technique
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f.) Susceptible host
- for infection to occur, the new host must be susceptible! They are:
Infants-immune system not mature, immunization not yet completed
Elderly-altered immune response due to aging; thin skin.
Lifestyle- promiscuity; drug and alcohol use
Occupation- healthcare worker
Medications- immunosuppresants
Conditions such as burns, surgery, etc.
-Nurse: Treat the underlying cause, and recognition of high risk patient.

*Health-care acquired infection (HAI): previously known as
nosocomial infection, infections acquired from healthcare facility.
Occurs 48-72 hours after admission.

*Community acquired infection (CAI): infection acquired in
community. Ct is admitted with/ develops signs and symptoms
24-48 hrs after admission.
*Infection: occurs when organism present in greater quantities
because of multiplying rapidly, causing host to become ill.
*Colonization: occurs when bacteria live within the body without
causing infection.

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3. Signs and Symptoms of Infection
First sign of infection is Fever (but not always!). Other: are specific to site, cts
age, and pathogen.
Site of Infection Signs and Symptoms
Urine Urgency, frequency, dysuria, suprapubic tenderness
Wound Purulent drainage (pus), Inflammation
Lungs Rales, productive cough, chest pain, SOB
Blood Chills, hypotension, oliguria
CNS HA, dizziness, altered LOC, skin rash, agitation
GIT Diarrhea, bloody stools, N/V, diarrhea

4. Preventing Infection
The Hospital infection control practices committee (HICPAC) of the CDC
recommends 2 tier of isolation precaution:

A.) STANDARD PRECAUTION Universal Precaution
Precautions used on Standard basis/ All the time when caring for all clients to
prevent exposure to infectious disease.
Tenets: all clients are colonized/ infected with M.O whether or not there are
Applies: To all blood, all body fluids, secretions, excretions, non-intact skin, and
mucous membrane.
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Purpose: Prevent transmission of nosocomial infection.

Hand Hygiene
Measures include:
a.) Hand washing:
>with soap and water when hands are visibly soiled.
>It is the single most important measure to reduce the risks of transmitting
pathogens from patient to another.
>The friction created during washing removes M.O.
b.) Alcohol-Based hand Rubs:
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>alternative to handwashing when hands are not visibly soiled. Efficacy and
convenience, but not sufficient to kill spores.
NOTE: Do not wear artificial fingernails/ nail extenders.

Personal Protective Equipment
a.) Gloves
>wear when in contact with blood/ body fluids.
>Wash hands after using gloves. Latex gloves are preferred than vinyl.

b.) Gown
>prevent soiling of your clothes; if your clothes are soiled, it must laundered by
hospital prior taking home.

c.) Goggles
>for eye protection-for spitting and coughing client. Also wear when suctioning
patient, procedures that may cause splashing.

d.) Mask
>for ct who is coughing/ risk of splashing; when client is on Respi isolation

e.) Caps and Shoe Covers
>protect client from hair of healthcare professional/ OR procedure.
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Needle Stick Prevention
>reduces risk of blood-borne infection; Extreme care when handling needles,
scalpels/ sharps.
>Used needle should not be recapped.

Precautions in addition to Standard precaution for some microbes that are so
contagious. Perform hand hygiene before and after contact.

Airborne Precaution
>For diseases transmitted through air. (Ex. Chickenpox, TB, Measles)
>Client should be kept in Negative-Pressure room (source isolation) to keep the air
in clients room when the door is opened.
>when client is to be transported to another hospital, surgical mask is placed on ct.

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Droplet Precaution
>droplets are heavy, they fall on ground. Therefore keep an arms length distance
from person coughing.
>Examples of diseases: Pneumonia MDR, Pertusis, Influenza, Mumps
>Wear surgical mask when caring for patient.
>pt is placed in private room/ if not available, room with the pt having active
infection with the same pathogen but with no other infection.
>special air-handling/ ventilation is not required.
>pt wear surgical mask when transported.

Contact Precaution
>used in diseases MRSA, Shigella, Lice, Scabies, Major draining abscesses,
incontinent diapered client.
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>require use of gowns and gloves in illnesses involving skin, illnesses transmitted
via fecal-oral route, direct-indirect contact illnesses.
>clients have dedicated equipment like BP, Stetoscope, Thermometer.
>most frequent MOT; Pt placed in private room; Limit pt transport.

Hospital acquired infections are a threat to population health and are not going
away any time soon. Due to frequent contact between health care workers and
patients, pathogens can be transmitted from one patient to another if good quality
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hand hygiene is not maintained. It is the responsibility of health care workers to
keep the patients in their care safe by modeling effective and frequent hand
washing practices. Nurses need to have a proactive voice in the promotion of
current best practices for hand washing hygiene.

V. R E F E R E N C E S
Understanding Pathophysiology, 3
Edition (S. Huether & K. McCance)
Brunner and Suddarths Textbook of MSN, 11
Hurst Reviews (Pathophysiology Review)
Burtons Microbiology