Infection Control Nur 120 Fall 20141 Final

BALTIMORE CITY COMMUNITY COLLEGE
DEPARTMENT OF NURSING
INTRODUCTION TO NURSING PRACTICE
Prof. Maria Robinson, RN, MS

Copyright 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
Fall 20141
INFECTION CONTROL & PREVENTION
Healthcare-associated infections (HAI) - infections that people

acquire while they are receiving treatment for another condition in a
health care setting.
Acquired anywhere health care is delivered

Inpatient acute care hospitals
Outpatient settings
Long-term care facilities
A.
B.
C.
Caused by pathogens, bacteria, fungi, viruses

and other less common protozoa
Significant cause of morbidity and mortality.
Cost the U.S. health care

system billions of dollars each year
INFECTION CONTROL & PREVENTION
Asepsis is the absence of contamination by diseasecausing microorganisms; it is essential to prevent HAI

reduce the transmission of infection, and to protect
patients and healthcare workers from infection.
NATURE OF INFECTION
Infection - invasion of a susceptible host by a

pathogen
Colonization presence and growth of a
microorganism within a host but without tissue
invasion or damage
Communicable disease infection transmitted
directly from one person to another
Symptomatic pathogen multiple cause
sign/symptoms
Asymptomatic clinical sign and symptoms are not
present
CHAIN OF INFECTION
The process by which infections spread is called the

chain of infection.
Made up of six links, all of which must be present for
infection to be spread from one individual to another.
CHAIN OF INFECTION
Infectious agent or pathogen - bacteria, viruses, fungi

Some microorganisms live on or in the body without causing harm.
Normal flora may become pathogenic if disease or injury permit
them to enter body regions they dont normally live
Reservoir a place where pathogens survive and multiply

Animals, insects, and humans are living reservoirs of
infection. Soil, water, food, surfaces can be nonliving
reservoirs.
carriers, have no symptoms of disease, but can transmit
disease to others.
CHAIN OF INFECTION
Portal of exitpoint of escape for the organism - the most

frequent portal of exit is through body fluids, including blood,
mucus, saliva, breast milk, urine, feces, vomitus, semen, or other
secretions.
Modes
of Transmission- Contact, either direct or direct, is the

most frequent mode of transmission of infection,
A vector is an organism that carries a pathogen to a susceptible host,
either by biting or by carrying the pathogen on its body. A common
vector for diseases, including malaria, yellow fever, is the mosquito.
Portal of Entry- Pathogens enter the body through a number of

portals of entry. conjunctiva of the eye, nares, mouth, urethra,
vagina, and anus are potential portals of entry, cuts and scrapes.
CHAIN OF INFECTION
Indirect contact involves contact with a fomite
(a contaminated object that transfers a pathogen). For example,
suppose that while you are charting you begin to sneeze and
cough, if you cover your nose and mouth with your hand and then
resume charting, you may transmit pathogens to the pen, paper,
and chart. Eyeglasses, stethoscopes, and other items we wear
also commonly serve as fomites, as do contaminated needles.
Question
Which of the following is the most significant and
commonly found infection-causing agent in
healthcare institutions?
A. Bacteria
B. Fungi
C. Viruses
D. Mold
Answer
Answer: A. Bacteria
Rationale:
Bacteria are the most significant infection-causing
agents in the healthcare system. Bacteria can be
categorized by shape, by their reaction to the
Gram stain, or according to their need for oxygen.
Fungi (molds and yeasts) can cause infection and
are present in the air, soil, and water.
Viruses cause infections including the common
cold and do not respond to antibiotics.
10
INFECTIONS CLASSIFIED BY LOCATION

AND DURATION
Local infections harm in a limited region of the body, such as the

upper respiratory tract, the urethra, or a single bone or joint
Systemic infections occur when pathogens invade the blood or
lymph and spread throughout the body.
Bacteremia is the clinical presence of bacteria in the blood.
Septicemia is symptomatic systemic infection spread via the
blood.
A primary infection is the first infection that occurs in a patient.
Following a primary infection, especially in an
immunocompromised patients, may be one or more secondary
infections
11
HEALTHCARE-ASSOCIATED INFECTIONS (HAI)
HAI may be exogenous infections pathogen acquired from the

healthcare environment or endogenous infections pathogen arises
from patients normal flora, and some form of treatment
chemotherapy or antibiotics causing normally harmless microbes to
multiply and cause infection
Iatrogenic infections develop from a therapeutic procedure - foley

catheter
Acute infections have a rapid onset but last only a short time
Chronic infections that develop slowly and last for weeks, months,
years - (HIV).
12
STAGES OF INFECTION
Incubation Period- the stage between successful invasion of the
pathogen into the body and the first appearance of symptoms.
The person does not suspect that he has been infected but may be
capable of infecting others. last only 1 day - influenza virus, or as
long as several months or even years.
Prodromal Stage- appearance of vague symptoms - Malaise, lowgrade fever, fatigue - person with herpes has itching and tingling
at site before actual lesions appear.
13
STAGES OF INFECTION
Illness Stage stage marked by the appearance of signs &

symptoms characteristic of the disease. strep throat is
characterized by sore throat, pain, and swelling. If the
patients immune defenses and medical treatments are
ineffective, this stage can end in the death of the patient.
Convalescence- characterized by tissue repair and a return

to health as the remaining number of microorganisms
approaches zero.
Convalescence may require only a day or two, or for severe
infections, as long as a year or more
14
BODYS DEFENSES AGAINST INFECTION?
The body has three lines of defense against infectious disease.
First, certain anatomical features limit the entry of pathogens.
Second, protective biochemical processes fight pathogens that do

enter.
Third, the presence of pathogens activates immune responses

against specific, recognized invaders.
The first two lines of defense are nonspecific; that means they have
no means of adapting their responses to each specific invader.
Instead, they act in precisely the same way against any and all
intruders, from a simple cold virus to deadly fungal spores.
15
IMMUNE RESPONSES
Antigen: foreign particles or substances
(i.e. virus or bacteria) that invades/enters the host
foreign invader
Antibody: formed in response to the antigen (virus or

bacteria). Protection produced by the body to protect
it from the foreign invader.
16
BODY SYSTEM DEFENSES

(SPECIFIC RESPONSE) ACQUIRED IMMUNITY
Active immunity
Occurs when antigen enters the body and body
responds by producing antibody. Body takes an
active role in making the antibody.
Natural (infection) or artificial (vaccine).
- Natural
- Artificial
17
BODY SYSTEM DEFENSES

(SPECIFIC RESPONSE) ACQUIRED IMMUNITY
Passive immunity
Acquired immunity resulting from antibodies
transferred from another human or animal.
Immediate short-term protection.
- Natural
- Artificial
18
Cas
PROMOTING HOST DEFENSES
e Study (contd)
Hygiene- Hygiene is crucial in maintaining skin

integrity. Intact skin is one of the best defenses
against infection. Frequent hand washing, as well
as regular showering or bathing, decreases the
bacterial count on the skin.
19
Infection Prevention and Control
Rest and Exercise Both rest and exercise are necessary to

rejuvenate the body.
Stress Reduction Stress, whether physical or mental,
decreases the bodys immune defenses. Studies show
correlations between increased stress and increased disease.
Laughing, in contrast, increases oxygenation, promotes body
movement, and increases immune responses.
Immunizations Immunization via vaccination can protect

against several infectious disease. Immunizations expose the
body to weakened or killed pathogens, stimulating an
immune response
20
NURSING ASSESSMENT
)
Ask the client about any exposure to pathogens in the

environment
Any unusual foods or products ingested
Past and present disease or injury history
Medications, OTC preparations, herbal products, alcohol
intake, and any substances currently in use
Current level of stress
Immunization history
Symptoms of illness
Observe general appearance
21
Question
Which one of the following infections or diseases
may be spread by touching a contaminated
inanimate article?
A. Rabies
B. Giardia
C. E. coli
D. Influenza
22
Answer
Answer: D. Influenza
Rationale:
Influenza may be spread if a person touches a
contaminated article and then touches his eyes or
nose.
The reservoir for rabies is animals; for Giardia,
water; and for E. coli, water or food.
23
Question
Tell whether the following statement is true or false.
Standard precautions should be used when caring
for a noninfectious, postoperative patient who is
vomiting blood.
A. True
B. False
24
Answer
Answer: A. True
Standard precautions should be used when caring
for a noninfectious, postoperative patient who is
vomiting blood.
25
Common Tests for Evaluating Presence of Risk

for Infection:
WBC count with differential- A breakdown of the types of WBCs;

normally WBC count is 5,000-10,000/cu mm
Blood cultures- a sample of blood placed on culture media and

evaluated for growth of pathogens.
Disease titers- blood tests for specific disease immunity
Panels to evaluate specific disease exposure- blood test to evaluate

exposure to specific diseases (i.e., HIV, hepatitis)
Immunoglobulin (IgG,IgM) levels- blood test to evaluate humoral

immunity status
26
Infection Prevention and Control
NURSING DIAGNOSIS
Risk for Infection r/t altered immune response secondary to
corticosteroid therapy
Risk for Infection r/t impaired skin integrity and poor nutritional
status.
PLANNING OUTCOMES/EVALUATION
Patient will show no signs of localized infection at the infusion

site, as evidenced by the absence of swelling, redness, excessive
warmth, pain, or drainage.
27
INTERVENTIONS/IMPLEMENTATION
Reduce exposure to pathogens through the use of

aseptic technique
Maintain skin integrity and natural defenses
against infection
Reduce stress
Promote immune function through collaborative
care.
28
Medical Asepsis
A state of cleanliness that decreases the potential for the

spread of infections.
Disinfection removes pathogens by physical or chemical

means not all pathogens are eliminated
Sterilization elimination of all microorganisms in or on

an object.
The most important aspect of medical asepsis is hand
cleanliness.
29
Droplet precautions
Pathogen can be spread via moist droplets - sneezing,
coughing, talking. Droplets can spread infection by
direct contact with mucous membranes or indirect
contact
Droplet precautions include the following:
Follow all standard precautions.
Follow all contact precautions.
Wear a mask and eye protection
when working within 3 feet of
the patient.
30
Airborne precautions
The spread of infections that are transmitted on air

TB, varicella (chickenpox), severe acute
respiratory syndrome (SARS), and rubeola
(measles). Pathogens that are spread by this
method are very small and can be easily
transmitted through ventilating systems
31
Airborne precautions

Follow all contact precautions.
Place the patient in a private room or in a room
with a patient with an infection caused by the
same organism and no other infections. Make
sure the room has negative air pressure and that
the air is discharged through a filtration system.
Wear a special mask (N95) if the patient is
suspected of having pulmonary TB.
32
Protective Environment/Protective
Isolation
Patients at high risk for infection are placed in a special form of

isolation . This type of isolation may be used for clients with low
WBCs or clients undergoing chemotherapy.
Healthcare workers caring for patients in protective isolation
should not be also providing care for other patients with active
infections.
When patients in protective isolation need to leave the room, they
should wear a mask and have minimal contact with others.
33
Protective Environment/Protective
Isolation
All persons entering the patients room should wear a

mask and wash their hands with soap and water.
After hand washing, caregivers and visitors should put on
a clean or sterile gown over clothing and take care to
keep the outside of the gown from any contact with
surfaces outside the room.
Once the gown is placed, don gloves.
If the mask or gown becomes wet while you provide
care, change it.
Once exiting the room, remove gloves, gown and mask
34
35
Surgical Asepsis
Sterile means without life. it contains no life and

therefore no infectious organisms. surgical
equipment, gauze dressings, or wound irrigation fluid
may be sterile.
Surgical asepsis requires creation of a sterile

environment and use of sterile equipment
36
Surgical Asepsis
high heat. Surgical equipment and implanted devices

must be sterilized.
To create a sterile area, personnel perform extensive

cleaning using special solutions and procedures.
A surgical scrub is an extended scrub of the hands

using brush, nail cleaner, and a bactericidal scrubbing
agent.
37
38

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BALTIMORE CITY COMMUNITY COLLEGE

Prof. Maria Robinson, RN, MS

INFECTION CONTROL & PREVENTION

Healthcare-associated infections (HAI) - infections that people

Acquired anywhere health care is delivered

Caused by pathogens, bacteria, fungi, viruses

Cost the U.S. health care

INFECTION CONTROL & PREVENTION

Asepsis is the absence of contamination by diseasecausing microorganisms; it is essential to prevent HAI

Copyright 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.

Infection - invasion of a susceptible host by a

The process by which infections spread is called the

Copyright 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.

Infectious agent or pathogen - bacteria, viruses, fungi

Reservoir a place where pathogens survive and multiply

Copyright 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.

Portal of exitpoint of escape for the organism - the most

of Transmission- Contact, either direct or direct, is the

Portal of Entry- Pathogens enter the body through a number of

Copyright 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.

Copyright 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.

INFECTIONS CLASSIFIED BY LOCATION

Local infections harm in a limited region of the body, such as the

Copyright 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.

HEALTHCARE-ASSOCIATED INFECTIONS (HAI)

HAI may be exogenous infections pathogen acquired from the

Iatrogenic infections develop from a therapeutic procedure - foley

Copyright 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.

Illness Stage stage marked by the appearance of signs &

Convalescence- characterized by tissue repair and a return

Copyright 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.

BODYS DEFENSES AGAINST INFECTION?

The body has three lines of defense against infectious disease.

First, certain anatomical features limit the entry of pathogens.

Second, protective biochemical processes fight pathogens that do

Third, the presence of pathogens activates immune responses

Antibody: formed in response to the antigen (virus or

BODY SYSTEM DEFENSES

Copyright 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.

BODY SYSTEM DEFENSES

Copyright 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.

Hygiene- Hygiene is crucial in maintaining skin

Copyright 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.

Infection Prevention and Control

Rest and Exercise Both rest and exercise are necessary to

Immunizations Immunization via vaccination can protect

Ask the client about any exposure to pathogens in the

Copyright 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.

Copyright 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.

Copyright 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.

Copyright 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.

Common Tests for Evaluating Presence of Risk

WBC count with differential- A breakdown of the types of WBCs;

Blood cultures- a sample of blood placed on culture media and

Disease titers- blood tests for specific disease immunity

Panels to evaluate specific disease exposure- blood test to evaluate

Immunoglobulin (IgG,IgM) levels- blood test to evaluate humoral

Infection Prevention and Control

Patient will show no signs of localized infection at the infusion

Copyright 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.

Reduce exposure to pathogens through the use of

Copyright 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.

A state of cleanliness that decreases the potential for the

Disinfection removes pathogens by physical or chemical