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Nursing Care Management of Clients with Infectious/Communicable Disease Dean Josephine De La Serna RN MN

Infectious and Communicable Disease Nursing

Infection and Communicable Disease brought about by a pathogenic microorganism

Communicable Disease can be spread in the same way as a n infectious disease

***can be interchanged

General Objectives

- To recognize the physiologic interaction between man and a microorganism that lead to a degree of subsequent pathology

- To help identify, prevent, and control communicable diseases

Specific Objectives

- Descriptive the infectious process with its complete chain of events

- Identify microorganism that serve as causative agents

- Use the biologic report as a primary source of information and tool to be used in the care of clients, along with clinical indications to determine whether a client is colonized, infected, or diseased.

- Play an active role in infection control and prevention in the hospital and the community

- Discuss changing patterns if infectious diseases in our present time

- Utilize the nursing process in the care of a client with an infectious disease

- Utilize statistical date to identify responses to problem presented by clients with infectious/communicable disease

Course Content

- See Copy on separate sheet

Evaluation Criteria

- Q 50% (60% Passing)

- TE 40%

- CP 10%

Why study CD/ID?

- Despite improve methods for treating and preventing infection, infection remains the most common cause of human disease and death.

-

Potent antibiotics up to 4 th generation

-

Complex immunizations

-

Modern sanitation

CD/ID can be

1. Mild person can go about with routine activities with little limitation

- E.g. Common colds

2. Debilitating stays for a long time, chronic

Nursing Care Management of Clients with Infectious/Communicable Disease Dean Josephine De La Serna RN MN

- E.g. Chronic Hepatitis

3. Fatal there is no definitive treatment, tx is only supportive

Infection

- E.g. AIDs

- Invasion and multiplication of microbes in or on body tissues, resulting in signs and symptoms as well as immunologic response.

- The more numerous, the higher degree of infection

- Immunologic process mechanism of the body to act and respond

Microbial reproduction injures the patient by:

1. Competing with the host metabolism

2. Causing cellular damage from toxins produced by the microbes or from intracellular multiplications

The severity of infection varies with:

1. Disease producing ability of microbes (determines the virulence of the microbe)

2. Number of the invading microbes (directly proportional to the severity of infection)

3. Strength of the host defences (hosts capacity to fight the infection/microorganism)

Communicable Disease

- Transmitted form one person to another

- Eg. Chickenpox

Contagious Disease

- Communicable disease that is easily transmitted from one person to another

- Easily transmitted; takes lesser time to be transmitted from one person to another

- Eg. Influenza

***in terms of transfer, shorter time of transmission (contagious) compared to communicable

Why outbreaks occur despite antibiotics and other effective therapies:

1. Some bacteria develop a resistance to antibiotics

- Unnecessary use of antibiotics

- Inappropriate prescribing of antibiotics

- Patient failure to complete the full course of antibiotic treatment (Usually 1week tid)

***once level of accumulation is reached in the blood, body is now responding to antibiotics, and so

- Use of antibiotics in animal feed

- Hereditary drug resistance extra chromosomal genetic elements with cell resistance (R) factors

- Effects of hospitalization special risk for drug-resistant infections

Very old

Very young

Seriously ill

Nursing Care Management of Clients with Infectious/Communicable Disease Dean Josephine De La Serna RN MN

Those patients on invasive procedures (using of an instrument to go into a body part; something sharp) ventilatory support

NGT non invasive

- Those already taking antibiotics antibiotics kill susceptible microbes allowing resistant strains to take hold

2.

Some microbes such as influenza virus have so many different strains that a single vaccine can’t protect them all

3.

Most viruses resist antiviral drugs (viral infections take a natural course)

4.

Some microbes localize in areas of the body that make treatment difficult including bone and CNS

5.

Opportunistic microbes can cause infections in immunocompromised patients leukemia, AIDS patient, cancer patients undergoing chemotherapy and radiation which destroy WBC

6.

Much of the world ever increasing population has not received immunizations

7.

Increasing air travel by the world population

8.

The use of biological warfare and bioterrorism

9.

The expanded use of immunosuppressive drugs and invasive procedures immunosuppressive drugs to prevent tissue rejection for transplants; wide variety of diagnostic tests

Terminologies

- Pathogens disease causing microorganism, microbes, germs

- Pathology scientific study of disease Pathos suffering Logos science ***Pathology is macro (or wider) so as epidemiology is under pathology

- Pathogenesis manner in which a disease develops

- Epidemiology study and investigation of diseases, esp its cause, transmission, occurrence, prevention and control (under pathologist)

- Etiology cause of disease (microorganisms)

- Communicable able to spread and pass on, transmitted

- Infectious may spread quickly

- Contagious may spread easily/directly form person to person

- Communicable Disease

- Any disease that spreads from one host to another directly or indirectly (Smeltzer and Bare)

- Any infectious disease that comes either directly or indirectly from another host (Bauman)

***direct immediate coming together of a surface to another

***indirect not directly in contact

- Non-communicable Disease

- A disease which does not spread from one person to another, only when introduced into a body (Tortora)

- An infectious disease that arises from outside of host or from (N) microbiota (Bauman)

- Contamination mere presence of pathogens in the skin

Nursing Care Management of Clients with Infectious/Communicable Disease Dean Josephine De La Serna RN MN

- Colonization – process by which strains of bacteria become resident flora, grows and reproduce but doesn’t produce disease ***colonized person can transmit disease to another without own self getting the disease

- Infection

- Invasion or colonization of the body by microbes

- Condition in which the host interacts physiologically and immunologically with a microorganism

- Presence of a microbe in a part of the body where it’s not normally found

- Virulence disease producing power of microbes

- Resistance – sum total of the body’s defenses which fro barriers to the progress of invasion or multiplication of infectious agents (capacity of the body to fight an infection)

- Pathogenicity ability to produce pathologic changes or disease

- Susceptibility degree of resistance an individual has to pathogens

- Contact – a person or animal who is in close ass’n with an infected person, animal or thing

- Carrier one who harbours microbes in his body without manifesting the disease

- Frank case one actually sick of a particular disease

- Fomites (Sing. Fomes) inanimate objects and materials on which disease-producing agents may be conveyed

A. Historical Perspectives Significant Persons

1. Antonie van Leeuwenhock

- Father of Microbiology

- First to describe microorganisms: Bacteria Protozoa

- Dutch Trade Man

- Animalcules

2. Louise Pasteur

- Discovered the Germ Theory of Disease

- Created the first vaccines for rabies (100% mortality from Rabies)

- Invented pasteurization (sterilizing milk and other food products)

3. Joseph Lister

- Pioneer of antiseptic surgery

- Use of antiseptic to control infections

- He used carbolic acid (Phenol)

4. Robert Koch

- Isolated Bacillus anthracis, TB bacillus, Vibrio cholera

- Developed the Koch’s postulate

5. Edward Jenner

- Pioneer of smallpox vaccine (almost similar to chicken pox but more contagious)

- Father of Immunology

6. Alexander Fleming

- Discovered Penicillin

7. Ignaz Semmelweis

- From Vienna, Austria discovered that handwashing decrease the incidence of death due to

infection following childbirth

8. Linnaeus - nomenclature

Nursing Care Management of Clients with Infectious/Communicable Disease Dean Josephine De La Serna RN MN

Microbiologists Pathologists one that examine tissues so that a more definitive can be given based on the report Medical Technologist Medical Practitioner Specializing in Infectious Disease

B. Factors that contribute to the emergence/incidence of CD

1. Societal Changes

- War

Crowded living conditions

Delivery of health care services is delayed

- Population growth esp third world countries

- Urban deterioration

- Unemployment

- Poverty

- Slum areas

- Migrant workers

2. Health Care System

- Use and abuse of antimicrobial agents OTC in the Philippines

- Reduce funding for CD control

3. Environmental/Ecological Changes

- Deforestation (environmental destruction)

- Housing/Village construction

- Mining

4. Technological Advancement

- Technology Good effect: people everywhere in the world can warn that there is an ongoing epidemic

- Bad effect exposure to radiation and chemicals

5. Human Behaviors

- Global travel (population movements)

- Sexual promiscuity (may be linked to poverty)

- Drug use

- Globalization of food supply

Trends in Infection

- Deaths from infectious diseases have declined greatly in industrialized nations

- Infectious diseases continue to be a major cause of death in developing countries

- “New” and “emerging” infectious diseases plague both industrialize and developing nations A(H1N1), Swine flu

General Characteristics and Nature of Infectious Diseases

1. According to Occurrence

Nursing Care Management of Clients with Infectious/Communicable Disease Dean Josephine De La Serna RN MN

- Sporadic occurs throughout the year (E.g. Typhoid fever); occurs throughout the year but very few or rare; very occasional and irregular in a certain population over a period of time, E.g. Flu and Typhoid; has the possibility to become endemic

- Endemic regular and constant, affects a certain population; present in a population regularly, number is not as great; (E.g. PTB); specific population (slum areas, crowded living conditions)

- Epidemic number of cases of endemic course of illness will increase; definite increase over its expected endemic pattern E.g. A(H1N1)

- Pandemic affects several countries worldwide

Incidence and Prevalence

Incidence number of new cases

Prevalence a combination of new cases and old cases; fraction of the population having the disease at a particular time

2. According to Severity/Duration

- Acute onset is sudden

Shorter span of time (2 weeks or less)

- Subacute

midway between acute and chronic

3 months, 2 months for the disease conditions to be solved

- Chronic gradual onset

Longer span of time

Extend up to months or years

- Latent

Microorganism is in the body but waits for an opportunity for the resistance to go down and brings about a disease condition

3. According to Extent of Host Involvement

a. Local affects a small area of the body (boils and abscesses) 5 Cardinal S/Sx of Local Infection

i. Rubor normal inflammatory response in case of infections causes vasodilation

ii. Calor heat on the part that is inflamed or infected (vasodilatation of blood vessels)

iii. Tumor swelling; production of exudates

Pus product of exudation

iv. Dolor pain; brought about by compression of nerve ending brought about by the swollen part; also caused by different toxins produced by the process of infection

v. Loss of function due to pain

b. Systemic spread throughout the body via the circulation (measles)

c. Inapparent or subclinical does not cause any noticeable signs of the disease in the host (Hep A, Polio virus)

Manifestations usually show after febrile stage

d. Focal when infectious agents of a local infection enter a blood or lymph vessel and spread to other specify parts of the body (those arising from infections in teeth, tonsils or sinuses)

Nursing Care Management of Clients with Infectious/Communicable Disease Dean Josephine De La Serna RN MN

4. According to its acquisition

a. Primary an acute infection that causes initial illness

b. Secondary

c. Nosocomial healthcare acquired

i. Hospital Acquired

ii. Community Acquired

d. Iatrogenic one that is acquired as a result of diagnostic and treatment procedure

E.g. Urinary Catheterization UTI, Phlebitis due to IV insertion

Chain of Infection

– UTI, Phlebitis due to IV insertion Chain of Infection Causative Agent – bacteria, virus, fungi,

Causative Agent bacteria, virus, fungi, algae, protozoa

Reservoir place where microorganism stay; person, animal, soil, water

Portal of exit a way by which causative agent goes out and readies to be delivered to susceptible host (nose, mouth, GI tract)

Mode of transmission

Portal of entry may also be a portal of exit

***break the chain of infection

What is the significance of Chain of Infection to Prevention of Disease?

See to it that we break the chain of infection to avoid occurrence of infection

***autoclaving, sterilization, environmental sanitation, hand washing, early recognition of microorganism = CAUSATIVE AGENT ***= MODE OF TRANSMISSION

HAND WASHING PERSONAL PROTECTIVE EQUIPMENT cap, mask, goggles, face shield, gowns, gloves ENVIRONMENTAL SANITATION IMMUNIZATION HEALTHY LIFESTYLE --- balanced nutritious food, rest, exercise

Nursing Care Management of Clients with Infectious/Communicable Disease Dean Josephine De La Serna RN MN

***typhoid fever = mask, gloves (fecal-oral route)

Course of Infection

a. Incubation Period period from the entry of a microorganism until the development of the signs and

symptoms of the disease; time interval between the initial infection and the first appearance of any signs and symptoms

- Host does not know that he will be sick

- Capable of transmitting the microorganism

- Rabies has incubation period of up to 20 years

b. Prodromal period in which the patient feels that there is something wrong, feels mild signs and symptoms of disease; not know the kind of disease; a relatively short period characterized by early, mild symptoms of the disease, such as general aches and malaise

- Capable of transmitting the microorganism

c. Period of Illness person exhibits S/Sx of the disease and the infectious agent (Full Stage); person can serve as reservoir of disease

d. Period of Decline - <24 hours to days, S/Sx subside, person is vulnerable to 2ndary infection

e. Period of Convalescence recovery has occurred and the person regains strength and the body returned to its pre-diseased state; person can serve as reservoirs for months or years

Relationship between Microbes and Host

- Symbiosis dissimilar organisms live an intimate and mutually advantageous partnership (most favorable)

- Mutualism when 2 organism interact, both benefit; may be similar organism (man and man)

- Commensalism one member of the relationship benefits without significantly affecting the other

- Parasitism one benefits and the other is either harmed, (some with slight damage) or killed, in the process, the parasite destroys its own home (Hookworms and tapeworm)

Defenses vs. Infections

1. Normal Flora permanent residents of certain body sites; non pathogenic in usual places; constitute protective host defense mechanism, limit growth of pathogens (E. Coli UTI)

2. Body System Defenses intact skin and mucous membranes of the RT, GIT, GUT, Repro Tract etc.

3. Inflammation process that neutralizes and eliminates pathogens or necrotic tissues; establishes a mean of repairing body cells and tissues Inflammatory Response (InR) the physiological reaction to injury or infection

4. Complement – “completes” the killing of bacteria; a complex of at least 20 serum enzymatic CHONs that mediate InR and amplify specific ImR

5. Interferons CHONs that acts to prevent multiplication of viruses in cells

6. Immune Response (ImR) – the body’s mechanism to protect itself

First Line of Defenses

I. Normal Flora

A. Resident all the time

Nursing Care Management of Clients with Infectious/Communicable Disease Dean Josephine De La Serna RN MN

B. Transient - here and now

- A variety of microbes on and inside our body

- Permanent residents of certain body sites: non-pathogens in usual places

- Does no harm and in some cases actually benefit us

- Under some circumstances they can make us sick or infect people we contact (can even kill us)

- Interferes with the establishment of pathogens from occupying a body surface by offering stiff competition for space and nutrition (microbial antagonism do not allow certain microorganism to come in)

- No (N) Microbiota in blood, bone, brain, heart, vascular system, lungs, esophagus, empty stomach, eyes, amniotic membranes, bag of water, uterus (Axenic environments)

How does (N) Microbiota cause disease?

- When they are outside where they are supposed to be

- Increase in usual number

1. Immune Suppression

- Radiation/CA chemotherapy

- Malnutrition, disease

- Emotional/physical stress

- Extremes of age

- Use of steroids to transplant patients

2. Changes in the microbiota

- Changes in the diet

- Hormonal changes

- Stress

- Long term antibiotic therapy

- Exposure to an overwhelming number of pathogens

- Introduction of a member of (N) microbiota into an unusual site in the body

II. Body System Defenses

A. External Barriers 1.Intact skin and mucous membranes

Impervious to most pathogens

2.Body secretions provide an inhospitable environment

Maintain ph that discourages colonization

“Washing” the area to keep organism from accumulating

3.Secrete germicidal substances 4.Stimulate the development of the immune system

B. Components of the Internal Defenses 1.Lymphatic system: Lymph, lymph nodes

Filtration/sensitization), thymus, spleen, tonsils, Peyer’s patches (In GI tract)

Provides for the components of teh internal defenses to circulate thought the body

Designed to capture and destroy invading microbes

Function both in InR and ImR

Nursing Care Management of Clients with Infectious/Communicable Disease Dean Josephine De La Serna RN MN

2.Leukocytes play an active roles in InR and ImR 3.Lymphocytes in ImR only; intercept antigens; circulate to lymph nodes, spleen, tonsils, lymph nodes, lymph tissue (Primary players: T-cells and Beta Cells) ***antigen foreign substances that stimulate production of antibodies 4.Mediators chemicals, CHONs (Chemotaxis, Leukotaxis, Opsonization)

Second Line of Defense (InR)

- Process that neutralizes and eliminates pathogens or necrotic tissues and establishes a means of repairing body cells and tissues

3 Interdependent Stages

a. Cellular response the same regardless of type of injury

b. Vascular response the arterioles, venules, capillaries dilate and become permeable

c. Phagocytosis engulfing, digesting, destroying infectious agents, cells debris and other small particles by circulating macrophages (neutrophils and monocytes)

Components of the 2 nd Line of Defense

1. Phagocytosis

5 Stages of Phagocytosis

i.

Chemotaxis attraction of phagocytic cells to an area (+ Chemotaxis, - Chemotaxis)

Bacteria will follow or draw towards chemical environment of greatest concentration

ii.

Adherence adhere to membrane

iii.

Ingestions of bacteria and debris

iv.

Digestion

v.

Elimination where the inflammatory process is completed and resolution (healing process)

2. Extracellular killing by WBC (Eosinophils and natural killer (NK) cells)

o Aka leukotaxis

3. Non specific Chemical Defenses vs. Pathogens

o Lysozyme, Complement, Interferons, defensins

4. Inflammation

5. Fever (by Pyrogens and Interleukin 1)

o If patient develops fever, it means he is protected

Third Line of Defense (ImR)

- Produces antibodies

I. Cell-mediated Response

o

Acts vs. Intracellular antigens

o

Triggered after foreign materials have been cleared from the area of inflammation

o

T- cells are activated, enter the circulation from lymph tissue and seek out the antigen

II. Humoral Response

o Antigen antibody response(ability of the body to develop a specific antibody to a specific antigen

Nursing Care Management of Clients with Infectious/Communicable Disease Dean Josephine De La Serna RN MN

o

Acts vs circulating antigens

o

Beta cells are activated

o

Antibody mediated

III. Acquired Immunity

- Resistance developed by a host as a result of a previous exposure to a disease

- Protection an animal develops vs certain types of microbes

- Or foreign

- Produces when the immune system is activated either naturally or artificially

Types of Acquired Immunity

Natural Acquired Active

Artificially Acquired Active

 

- Antigens enters body naturally

- Body produces

anti-bodies

and

specialized

- Body produces antibodies and specified lymphocytes

lymphocytes upon vaccination

 

- Body takes an active role (compared to passive)

 

- Patient develops mild signs and symptoms of disease (compared to passive)

Natural Passive

Artificially Acquired Passive

 

- Antibodies pass from mother to fetus via placenta or milk

- Antibodies in immune serum introduced into the body by injection

IV. Immunoglobulin

- Specialized CHONs;

- Form of antibodies given to a person, coming from an animal or person who has had the disease (passive immunity)

- Given to pregnant women to prevent congenital abnormalities to babies

Principles and Procedures in Preventing CDs and Controlling Transmission

3 Principal Approaches

1. Elimination or containment of the sources of infection kill breeding grounds of mosquitoes

2. Interruption in the important mechanism of transmission

3. Protection of the susceptible host isolation, quarantine, barrier precautions, increase immune system through healthy lifestyle

Control Measure Geared On:

1.

Killing or altering virulence of pathogens (Chemoprophylaxis) by use of drugs, antiviral, antimicrobial

2.

Destroying non-human reservoirs and vectors (Physical/Chemical Methods)

3.

Isolating and segregating infected persons

4.

Using precaution with infected body fluids/contaminated objects body secretion, precaution and drainage precaution

5.

Development of vaccines

6.

Education

Nursing Care Management of Clients with Infectious/Communicable Disease Dean Josephine De La Serna RN MN

Principles of Basic Infection Control

- Microorganisms move on air currents

- Avoid shaking or tossing linens

- Doors leading to rooms used as a respiratory isolation are kept closed to stop air currents

- Ventilation system:

a. TB negative pressure (door opened -> air from the corridor moves)

b. Operating room: + pressure (door opened -> air doesn’t move in to contaminate)

- Microorganisms are transferred from one surface to another whenever objects touch

- Clean item -> less clean item = dirty microorganisms transferred to it

- Keep hands away from own face and hair

- Keep linens away from your uniform

- Separate clean and dirty linens

- If you drop anything on the floor, consider it dirty

- Microorganisms are released into the air on droplet nuclei whenever a person breathes or speaks

- Safe distance = 3 feet away

- Coughing and sneezing dramatically increases the # of microbes released from the mouth and nose (forceful)

a. Avoid having a patient breath directly to your face

b. Avoid breathing directly into a patients face

- Microorganisms move slowly on dry surfaces but quickly through moisture

- Used dry paper towel to turn off faucet

- Don’t use moistened towel

- Dry bath basin before returning to a bedside stand and storage

- Proper hand washing removes many microorganism that can be transferred by the hands from one item to another

a. Before patient contact

b. Before sterile task

c. After blood or body fluid exposure (obviously soiled)

d. After patient contact

e. After contact with patient’s surroundings

Control and Elimination of Infectious Agents

Isolation segregation/separation of a person with infectious disease from other persons to prevent the spread of infections or potentially infectious microorganism to health personnel, clients and visitor

***One person per room in isolation

***Group together patients with same diagnosis and infection

Rationale for Isolation

1. To prevent the spread of infection

a. From client to client

b. From client to health care worker

c. From health care worker to client

Nursing Care Management of Clients with Infectious/Communicable Disease Dean Josephine De La Serna RN MN

d. From client to visitor

e. From visitor to client

2. To lessen the risk of infection in immunocompromised clients

Isolation Based Theory

- It is appropriate to isolate persona presumed contagious when more specific preventive measure are unknown or unfeasible (Wehrle and Top)

- In case of doubt, isolate the patient

***If unsure/doubt if patient is infectious, isolate the patient

Isolation Categories

- See handouts

STRICT

- Purpose: prevents transmission of highly contagious or virulent infections spread by air and contact

- Eg. chickenpox, diphtheria

- Room: Private room with door closed

- Gown: required of all persons entering room

- Gloves: required of all persons entering room

- Mask: required of all persons entering room

- Precautions: discard or bag and label articles contaminated with infective material. Send reusable articles for disinfection and sterilization

- NEED MASK, GLOVES, GOWN

CONTACT

- Purpose: prevents transmission of highly transmissible infections spread by close or direct contact, which not warrant strict precautions

- Eg. acute respiratory infections in infants and young children; impetigo; herpes simples; infections by multiple resistant bacteria

- Private room: clients infected with same organsism amy share room

- Gown: indicated if soiling or contact likely

- Gloves: indicated for persons touching infective material

- Mask: INDICATED FOR PERSONS COMING CLOSE TO CLIENT

- Precautions: discard or bag and label articles contaminated with infective material. Send reusable items for disinfection and sterilization

- SUCTIONING: GLOVES AND MASK

- ASK PATIENT: DO NOT NEED ANYTHING UNLESS STAY CLOSE TO PATIENT

RESPIRATORY

- Purpose: prevents transmission of infectious diseases over short distances by air droplets

- Eg. measles, meningitis, mumps, pneumonia, haemophilus influenza (in children)

- Room: private room: clients infected with same organisms may share room

Nursing Care Management of Clients with Infectious/Communicable Disease Dean Josephine De La Serna RN MN

- Gown: not indicated

- Gloves: not indicated

- Mask: indicated for persons who come close to client

- Precautions: discard or bag and label articles contaminated with infective material. Send reusable items for disinfection and sterilization. Bathroom should not be shared with clients.

ACID-FAST BACILLUS ISOLATION

- Purpose: is special category for clients with pulmonary tuberculosis who have positive results on sputum or chest xray examination indicating active disease

- Eg. pulmonary or laryngeal tuberculosis

- Room: Private room with special ventilation (air from adjacent rooms and corridors must flow into, not out of isolation room). Exhaust air must not be recirculated; door closed

- Gown: indicated only if needed to prevent gross contamination of clothing

- Gloves: not indicated

- Mask: well-fitting, high filtration mask. Ordinary surgical masks offer little protection.

- Precautions: articles are rarely involved. In transmissions of tuberculosis. Articles should be thoroughly cleansed, disinfected or discarded

- MOST NEED PPE EQUIP: MASK (HIGH FILTRATION MASK = N95)

ENTERIC PRECAUTIONS

- Purpose: prevents infections transmitted by direct or indirect contact with feces

- PPE MOST NEEDED: GLOVES, and mask (for odor)

DRAINAGE/SECRETION PRECAUTIONS

- Purpose: prevents infections transmitted by direct or indirect contact with purulent material or drainage from infected body site

- Eg. abscess; burn infection; infected wound; minor infection snot included in contact isolation

- Room: private room not indicated

- Gown: indicated if soiling or contact with infective material is likely

- Gloves: indicated when touching infective material

- Mask: not indicated

- Precautions: Discard or bag and label articles contaminated with infective material. Send reusable articles for disinfection and sterilization.

UNIVERSAL PRECAUTIONS

- Purpose: prevents transmission of blood-borne pathogens by direct ofr indirect contact; must be practiced with all clients as a minimum standard

- Eg. AIDS, hepatitis E, syphilis

- Room: Private room indicated if client’s hygiene is poor

- Gown: indicated during procedures likely to generate splashes of blood or body fluids

- Gloves: indicated for touching blood or body fluids containing visible blood, mucous membranes or nonintact skin of all clients; indicated for touching soiled items

Nursing Care Management of Clients with Infectious/Communicable Disease Dean Josephine De La Serna RN MN

- Mask: indicated during procedures likely to generate droplets of blood

- Precautions: Discard or bag and label articles contaminated with blood or body fluids. Disinfect and sterilize articles. Avoid needle stick injuries. Dispose used needles in properly labeled, puncture-resistant container. Clean blood spills with 5.25% solution of sodium hydrochloride diluted 1:10 with water.

- SPECIAL PRECAUTION TO TAKE: CARE OF BLOOD AND BODY FLUIDS (NEEDLES, DISCHARGES) PLACED ON SPECIAL PLASTIC BAGS

NEUTROPENIC PRECAUTIONS or REVERSE ISOLATION

- Purpose: protects uninfected client with lowered immunity and resistance from acquiring infectious organisms

- Eg. leukemia, lymphoma, aplastic anemia (with blood problems)

- Room: private room with door closed

- Gown: required of all persons entering room

- Gloves: required of all persons entering room

- Mask: Indicated for persons coming in contact with client

- Precautions: for open wounds or burns, use sterile gloves

What type of PPE Would You Wear?

1. Giving a bed bath?

None (will need gloves if there are discharges from any openings esp skin; will need

mask when patient is having disease condition where droplet nuclei is source of contamination)

2. Suctioning oral secretions?

catheter

Gloves = will likely touch patient’s secretions; Mask if not skillful in handling

3. Transporting a patient in a wheel chair?

4. Responding to an emergency where blood is spurting?

5. Drawing blood from a vein?

6. Cleaning an incontinent patient with diarrhea?

7. Irrigating a wound?

8. Taking vital signs?

None

Gloves, mask, gown, face shield

Gloves

Gloves, gown

Gloves, gown , mask

None

How often do you clean your hands after touching a patient’s intact skin? ALWAYS Remember to your part for patient safety: FOLLOW good hand hygiene practices.

Definitions

Hand hygiene performing hand washing, antiseptic hand wash, alcohol-based hand rub, surgical hand hygiene/antisepsis (BETTER THAN HAND WASHING)

Hand washing

Use gloves blood and body fluids, soiled patient care equipment or used linen Mask/eye protection and gown when splashing of blood or body fluid

Sequencing for Donning PPE

1. Gown first

2. Mask or respirator

3. Goggles or face shield

4. Gloves

Nursing Care Management of Clients with Infectious/Communicable Disease Dean Josephine De La Serna RN MN

How to Don a Gown?

- Select appropriate type and size

- Opening is in the back

- Secure at neck and waist

- If gown is too small, use two gowns (gown #1 ties in front, gown #2 ties in back ==== put on the one in back first then in front)

How to Don a Mask?

- Place over nose, mouth and chin

- Fit flexible nose piece over nose bridge

- Secure on head with ties or elastic

- Adjust to fit

How to Don Gloves

- Don gloves last

- Select correct type and size

- Insert hands into gloves

- Extend gloves over isolation gown cuffs --- beyond radial area

Sequence for Removing PPE

1. Gloves

2. Face shield or goggles

3. Gown

4. Mask or respirator

How to Remove Gloves ---- GLOVE-TO-GLOVE TECHNIQUE

- Grasp outside edge near wrist

- Peel away from hand, turning glove inside-out

- Hold in opposite gloved hand

- SKIN-TO-SKIN TECHNIQUE

Removing Eye Shield

- Grasp ear or head pieces with ungloved hands

- Lift away from face

- Remove on two sides

Removing Isolation Gown

- Unfasten ties

- Peel gown away from neck and shoulder

- Turn contaminated side inward

- Roll the gown

Quarantine

- Is the limitation of the freedom of movement of persons with infectious diseases, for a period equivalent to the period of the communicability of the disease

Nursing Care Management of Clients with Infectious/Communicable Disease Dean Josephine De La Serna RN MN

Quarantine-Based Theory

- A CD suspect is isolated for 40 days until infectivity should theoretically have ended (Wehrle and Top).

- Chemoprophylaxis use of pharmacologic agents to control infection

- Antisepsis reduction in teh number of microorganism and viruses, particularly potential pathogens, on living tissue ***sterility: all microbes (pathogenic or nonpathogenic) are removed including their spores ***antiseptics: reduce to a minimum

- Degerming removal of microbes by mechanical means (eg. dusting, mopping, washing, taking a bath)

- Disinfection destruction of most microorganisms and viruses on non living tissue ***disinfection and antiseptics are used interchangeably. Antisepsis coupled with antiseptic solution (Zonrox, mouth wash, Cidex)

- Sterilization destruction of all microorganisms and viruses in, or on, an object (including spores) autoclave

- Sanitization removal of pathogens from objects to meet public standards handwashing with safeguard

- Cleaning reduces growth of microbes but do not totally remove them for soiled equipment at home

1. Rinse with cold H20

2. Wash with warm, soapy water

3. Rinse to remove soap

4. Use a stiff brush to clean equipments with grooves and corners

***hot water effect on secretions: secretions contain CHON -> coagulate if with hot water -> stick to instrument :::: thus rinse with cold water first

- Pasteurization

use of

moderate heat to

destroy

pathogens

and

reduce

the number

of

spoilage

microorganisms in foods and beverages (15seconds @ 72 degrees Celsius)

Dairy Fruit Juices Beer Wine

- Autoclaving

- Steam under pressure

- Usually operated @ 121Degrees Celsius

- 15lbs pressure/square inch

- Time needed for procedure depends on materials being sterilized

- Laboratory/medical supplies that can tolerate heat and moisture

- Boiling

- denatures CHONs and destroys membranes

- 10 minutes @100Degrees Celsius

- Sterilization of restaurant cookware and tableware

- Ultra High Temperature Sterilization

- 1-3 seconds @ 140Degrees Celsius

- Sterilization of dairy products

- Dry Heat Hot Air Oven

- 2 hours @ 160Dec Celsius or 1 hour @ 171Deg Celsius

- Denatures CHONs, destroys membranes

Nursing Care Management of Clients with Infectious/Communicable Disease Dean Josephine De La Serna RN MN

- Oxidize metabolic compounds

- Sterilization of H30 Sensitive materials: Powders, oils and metals

- Incineration

- 1 sec @ >1000Deg Celsius

- Sterilization of inoculating loops, flammable contaminated medical wastes, disease carcasses

- Same as cremation of the dead

- Radiation all types of radiation injurious to microbes

a. Ionizing radiation destroys DNA Ex. Electron beams, gamma and x-rays

Sterilization of medical and laboratory equipment, preservation

b. Non-ionizing radiation (UV light)

- Inhibits DNA transcription and replication

- OR, nurseries, labs, schools, food establishments

- Refrigeration

- 0-7Deg Celsius inhibits metabolism and microbial multiplication; preservation of food

- Environmental Sanitation

- Is the study of all factors in man’s physical environment which may exercise a deleterious effect on his well-being and survival (Public Health Nursing in the Philippines NLPGN Inc., 10 th edition, p.311)

Water Sanitation

Food sanitation

Refuse and Garbage disposal

Air pollution

Noise

Radiological protection

Institutional sanitation

Stream pollution

Chemical Methods of Microbial Control for body and inanimate objects

- Antiseptic inhibits microbial growth

- Disinfectant destroys pathogenic microbes and inhibits microbial growth (more concentrated)

- Germicide destroys pathogenic microbes

- Bactericide destroys bacteria

- Fungicide destroys fungi

- Varicide destroys viruses

***disinfectant (alcohol, Zonrox) is more concentrated than antiseptic (Listerine, mouth wash) Commonly Used Chemical Agents

1. Ethyl Alcohol (70%)

2. Isopropyl Alcohol (80%)

3. Benzalkonium Chloride 1:1000 Zephiran

4. Hydrogen Peroxide (3%)

Nursing Care Management of Clients with Infectious/Communicable Disease Dean Josephine De La Serna RN MN

5. Silver nitrate (1%)

6. Iodine and iodine releasing compounds

7. Substituted phenols

8. Ethylene oxide OR for anesthetic machine

Protecting the Host and Improving Susceptibility

- Use hygienic practices to maintain skin and mucous membranes as 1 st line of defense

- Reinforce or maintain natural protective mechanisms such as coughing, pH of secretions, resident flora

- Promote./maintain proper and good nutrition and encourage rest and sleep to promote tissues repair and production of lymphocytes and antibodies

- Educates client about immunization and on teh availability of health services

Notifiable/Reportable Disease

- Refers to a disease that, by legal requirements, must be reported to a public health or other authority, in the pertinent jurisdiction when the diagnosis was made (DOH AO 2007-0036), (DOH AO 2008-0009) Ferb. 12, 2008, RA 3573

Immediately Notifiable Disease/Syndrome/events and conditions (Category I)

- Immediate notification is required for the epidemic-prone diseases that newly appear in a population or have existed but are rapidly increasing in incidence. This also includes epidemic-prone diseases targeted for eradication and elimination. The Disease Reporting Unit (DRU) shall notify simultaneously the PHO, CHD, and NEC within 24 hours of detection by the fastest means possible even a single cause of such

disease. A case-based investigation report shall be submitted to the above-mentioned offices by facsimile or e-mail.

1. Acute flaccid paralysis --- in polio

2. Adverse event following immunization (AEFI)

3. Anthrax

4. Human avian influenza

5. Measles

6. Meningococcal disease

7. Neonatal tetanus

8. Paralytic shellfish poisoning --- red tide

9. Rabies

10. Severe acute respiratory syndrome (SARS)

11. Outbreaks

12. Clusters of diseases

13. Unusual diseases or threats

Category 2 reported weekly Acute bloody diarrhea syndrome Acute encephalitis syndrome Acute hemorrhagic fever syndrome Acute viral hepatitis Bacterial meningitis

Nursing Care Management of Clients with Infectious/Communicable Disease Dean Josephine De La Serna RN MN

Cholera Dengue Diphtheria Influenza like illness Leptospirosis Malaria Non-neonatal tetanus Pertussis Typhoid and paratyphoid fever

Nursing Care and Management

Involves the ff:

- Self protection

- Prevention of spread (medical asepsis and concurrent disinfection)

- Physical care

- Emotional support

- Spiritual support

***Nurses’ responsibility extends beyond the immediate care

Nurses must be knowledgeable in:

- Nature of specific microbes

- Most effective methods of destruction

- How pathogens invade host, routes of escape

- Incubation period, prodromata, length of communicability

- How a specific drug alters the clinical signs and the infectious course of the disease

- Most recent methods and concepts of prophylaxis for CD

- Rationale of control measures, isolation techniques

4 Aspects of Care

- Preventive

- Health Education

- Immunization

- Environmental Sanitation

- Control System

- Isolation (8categories)

- Quarantine

- Disinfection(Concurrent and terminal)

- Disinfestations(Physical/chemical means)

- Fumigation(Disinfectant fogging)

Nursing Care Management of Clients with Infectious/Communicable Disease Dean Josephine De La Serna RN MN

- Curative

- Medical Management

- Nursing Management

- Rehabilitative

- Activity

- Nutrition

Potassium Manganese Crystal for fumigation Assessment

Challenges to the Nurse

o

Infectious agent cause a wide range of disease

o

Symptoms vary from highly specific (Pathognomonic sign) to a generalized feeling of illness

o

Susceptibility to infection increases with poor nutrition, chronic disease, stress, fatigue, immunosuppression

o

Many infectious diseases follow a reasonably predictable risk pattern in which they occur more commonly in certain individuals

o

Certain behaviors put persons at risk

Parts of Assessment: Nursing history, Physical Assessment, Laboratory and Diagnostic Exam

Nursing Health History

Factors relating to infectious diseases

1. Potential exposure to infectious agents

2. Risk factors that alter host resistance to the disease

3. Medical history related to increased risk of infections (Leukemia)

4. Previous infections

5. Immunization history

6. Present complaint for visit

Diagnostic Tests to Screen and Confirm Certain Infection/Ids

1. Based on manifestations: local/systemic

2. Hematologic Test

3. Skin Tests

4. Microscopic Exams

5. Antibiotic Sensitivity Testing

6. Cultures

7. Immunologic Tests

Nursing Care Management of Clients with Infectious/Communicable Disease Dean Josephine De La Serna RN MN

Manifestations of Infection

Local

1. Pain Dolor

2. Redness Rubor

3. Swelling tumor

4. Warmth Calor

Systemic

1. Fever increased metabolic rate (inc in PR and RR); as we breath, we give off heat

2. Increased PR and RR

3. Lethargy sleepy, drowsy

4. Anorexia

5. Enlarged Lymph Nodes lymphadenopathy

II. Hematologic Tests

1. WBC

- 4500-11000/mm3;

- provides info on client’s response to disease and treatment

- Critical values: <2500mm3, >30000mm3

2. WBC Differential identifies and enumerates N L M E B, also bands and segmenters

Total Neutrophils: 50-70% Bands 0-5% - bacterial infections Lymphocytes 25-35% - viral/chronic Monocytes 4-6% - viral/chronic inflammation Eosinophils 1-3% - allergic/parasitic Basophils .4-1.0% acute or sever infection

3. ESR

-

InR,

Rheumatoid/autoimmune disorders, Temporal arthritis, Polymyalgia rheumatica, course of an infectious process and client’s response to treatment; acute/severe bacterial infection (Wintrobe, Westergren)

M

40-50%

F

38-47%;

assists

in

the

diagnosis

of

acute/chronic

infection

acute

- Increase in case of infections

4. C-Reactive Protein

- 6.8-820micrograms/dL

- Detect the increase or exacerbation of inflammatory process

- Ii 4-6 hours after onset, decreases rapidly as InR begins to resolve

5. Intracellular Enzymes ca be detected in serum following inflammation/injury

- ALT Alanine Aminotransferase (SGPT)

o

Produced by teh liver

o

To track course of liver disease

o

To monitor liver damage due to hepatotoxic drugs

o

To monitor response to liver disease treatment’

Nursing Care Management of Clients with Infectious/Communicable Disease Dean Josephine De La Serna RN MN

o Routine screen for hepatitis (donor blood samples rejected if levels are >1.5x the upper limits of normal (F: 7-35 U/L) *M:10-40U/L)

- AST Aspartate Aminotranspeptidase

o Rises when there is cellular damage to tissues where the enzyme is found: liver, myocardial cells, skeletal muscle, kidneys, pancreas, brain

- LDH Lactate Dehydrogenase (313-618 U/L)

o Non specific indicator of cellular damage because LDH is found in every tissue of the body

6. Lactic Acid Levels increases in teh + of bacteria but not virtues (E.g. CSF: Bacterial vs viral meningitis)

7. Ig Ratio aids in differentiating current/past infection/immunization Serum IgM Inc levels = current infection

- Levels generally peak 1-2 weeks after antigen is introduced (active infection) and

- Decrease during the convalescence period

Serum IgG Inc levels = previous infection

- Placental transfer of maternal antibodies

- Previous active or passive immunization

- Peaks during convalescence

***A 4 fold rise in antibody titer during convalescence indicates concurrent infection

III. Skin Tests

- Based on the principle that an intradermal injection of either certain antigens or toxins produces a local (cell mediated) reaction if a person has recently been infected with a particular antigen

- Y Antibody Test TB (Mantoux Test, PPD, Tine test <leaves a scar>)

- Y Toxin Tests Diphtheria (Schick Test)

IV. Microscopic Exams

- Scarlet Fever (Dick Test)

- Only method of identifying parasites/ova

- Distinguishes tissue cells from microorganisms

- Permits a presumptive diagnosis V. Antibiotic Sensitivity Testing

- Adding antimicrobials to a culture to determine whether an organism is inhibits from growing or is dead

VI. Culture Test

- Use liquid/solid medium

- Positively identifies organism depending on:

- Type of Microorganism (Pneumococcus)

- Type of Specimen (E.g. S. Typhosa)

- Stage of Illness (E.g. TB)

VII. Immunologic Test measures antibody titers

Nursing Care Management of Clients with Infectious/Communicable Disease Dean Josephine De La Serna RN MN

I. Agglutination Tests

- Demonstrates ability of antibodies and antigens to bind together (clumping)

- Used in blood typing

- Used in identifying antibodies vs many bacterial, fungal, parasite nad a few viral infections 2 Types

1. DAT antibodies attach directly to antigens

2. IAT antigens must 1 st be coated with chemicals that attract antibodies

Enzyme-Linked Immunoabsorbent Assay (ELISA) more sensitive than CIE in detecting antigens and antibodies associated with B, F, V, P infections: HIV, Hepa A and B, Rubella

Radioimmunoassay (RIA) highly sensitive, can detect small mounts of antigen or antibody; useful in diagnosis of Hepa B

Immunofluorescent Antibody Assay (IFA) antigen-antibody binding can be observe under a fluorescent microscope when either antigens or antibodies are tagged with a fluorescent dye

VIII. Other Immunologic Tests

Limulus Lysate Assay detects endotoxins in CSF produced by gram negative bacteria (N. Meningitidis, E.Coli, H. Influenzae)

Antigen-Antibody reactions that can be observed microscopically: Immobilization, opsonization, and phagocytosis, and capsular swelling (quelling reaction)

o Ex. TPI (Treponema Pallidum Immobilization) test detects capsular swelling; diagnosis of syphilis

Neutralization tests uses the principle that if neutralizing antibodies or antitoxins are +, tissue destruction is prevented

Nursing Process refer to hand out

10 Leading Causes of Mortality

2007

2004

1. Heart Disease

1. Heart Disease

2. Diseases of the Vascular System

2. Diseases of the vascular System

3. Pneumonias

3. Malignant neoplasm/cancers

4. Malignant neoplasm/cancers

4. Accidents

5. All forms of Tuberculosis

5. Pneumonias

6. Accidents

6. All forms of TB

7. COPD and allied conditions

7. COPD and allied condition

8. Diseases of Respiratory system

8. Respi diseases

9. Diabetes mellitus

9. DM

10. Nephritis/nephrotic Syndrome

10. Nephritis/Nephrotic Syndrome

Nursing Care Management of Clients with Infectious/Communicable Disease Dean Josephine De La Serna RN MN

Emerging Infectious Diseases (CDC 1994)

What?

- Infections that have newly appeared in a population or have existed but are rapidly increasing in incidence or geographic change (Kwan-Gett p.1-5)

- Diseases of infectious origin with human incidence that have increased within the past 2 decades

- That are likely to increase the near future (Smeltzer and Bare, pp. 2125)

Why?

- Human actions in the environment

- Social forces worsened by war and economic disparity

3 Categories of EIDs

- Diseases that have not previously occurred in human (SARS)

- Diseases that have occurred previously but affected only small #’s of persons in isolated locations (Ebola, AIDS)

- Diseases that have occurred thought history bust have only been recently recognized as distinct disease caused by an infectious agent (Lyme Disease, Gastric Ulcers)

Diseases Surveillance and Response Network: to control the spread of infectious disease, draw statistical data….

- GOARN Global Outbreak and Response Network to control the spread of communicable disease, make a study, draw statistical data and inform one another of the situation in various area)

- 122 member countries involve in GOARN

- PIDSR Philippines Integrated Disease Surveillance and Response main office at Manila

- NOCHESS Negros Occidental Health Epidemiology and Surveillance System

- CDCS Community-based Disease Surveillance System