IVCC Nursing 1202 Unit 2

absence of disease producing microorganisms

Infection (definition)
invasion of body tissue by microorganism

presence and growth of microorganisms within a host but without tissue invasion or damage

an infectious disease transmitted directly from 1 person to another

healthcare associated infections

how HAI’s occur (either exogenous or endogenous)
occur as a result of invasive procedures, antibiotic administration, the presence of multidrug-resistant organisms, and breaks in infection prevention and control activities

Major sites of HAI’s
surgical or traumatic wounds, urinary and respiratory tracts, and bloodstream

a type of HAI caused by invasive diagnostic or therapeutic procedure

Examples of iatrogenic’s
IV catheter insertion infection (UTI), patient on ventilator gets pseudomonas (pneumonia), bronchoscopy and treatment with broad-spectrum antibiotics increase the risk

comes from microorganisms found outside the individual, such as Salmonella, Clostridium tetani, and Aspergillus

occurs when part of the patient’s flora becomes altered and an overgrowth results (e.g., staphylococci, enterococci, yeasts, and streptococci). This often happens when a patient receives broad-spectrum antibiotics that alter the normal floras. When sufficient numbers of microorganisms normally found in one body site move to another site, this kind of infection develops.

The cycle of infection (must have all to have an infection)
an infectious agent or pathogen, a reservoir or source for pathogen growth, a port of exit from the reservoir, a mode of transmission, a port of entry to a host, and a susceptible host

Potential for disease
depends on number of microorganisms present, their virulence, their ability to enter and survive in a host, and the susceptibility of the host

ability to produce a disease

How resident flora can hurt us
resident skin microorganisms are not virulent. However, these skin microorganisms can cause serious infection when surgery or other invasive procedures allow them to enter deep tissues or when a patient is severely immunocompromised (has an impaired immune system).

Transient microorganisms
attach to the skin when a person has contact with another person or object during normal activities. For example, when you touch a contaminated gauze dressing or cleanse a patient following diarrheal episode. These organisms may be readily transmitted unless removed using hand hygiene.

a place where microorganisms survive, multiply, and await transfer to a susceptible host

Frequent reservoirs for HAIs
health care workers, especially their hands; patients; equipment; and the environment

2 types of human reservoirs
those with acute or symptomatic disease and those who show no signs of disease but are carriers of it

What microorganisms need to survive
to thrive organisms require a proper environment, including appropriate food, oxygen, water, temperature, pH, and light

C. difficile
a common spore-forming bacterium and an organism that causes antibiotic-induced diarrhea

cold temperatures tend to prevent growth and reproduction of bacteria

a temperature or chemical that destroys bacteria

Preferred pH for bacteria
range of 5.0 to 7.0. Bacteria in particular thrive in urine with an alkaline pH.

Portal of exits
blood, skin and mucous membranes, respiratory tract, genitourinary (GU) tract, gastrointestinal (GI) tract, and transplacental (mother to fetus)

Types of contact transmission
direct, indirect, droplet, and airborne

Direct transmission
person-to-person (fecal, oral) physical contact between source and susceptible host (e.g., touching patient feces and then touching your inner mouth or consuming contaminated food)

Indirect transmission
personal contact of susceptible host with contaminated inanimate object (e.g., needles or sharp objects, dressings, environment)

Droplet transmission
large particles that travel up to 3 feet during coughing, sneezing, or talking and come in contact with susceptible host

Airborne transmission
droplet nuclei or residue or evaporated droplets suspended in air during coughing or sneezing or carried on dust particles

Vehicles for transmission
contaminated items, water, drugs, solutions, blood, and food (improperly handled, stored, or cooked; fresh or thawed meats)

Vectors for transmission
external mechanical transfer (flies) and internal transmission such as parasitic conditions between vector and host such as: mosquito, louse, flea, and tick

Unwashed hands
major route of transmission for pathogens identified in the health care setting

Another source in healthcare (for transmission of pathogens)
equipment used within the environment (e.g., a stethoscope, blood pressure cuff, or bedside commode)

Portal of entry
organisms enter the body through the same routes they use for exiting. For example, during venipuncture when a needle pierces a patient’s skin, organisms enter the body if proper skin preparation is not performed first. Factors such as a depressed immune system that reduce body defenses enhance the chances of pathogens entering the body.

Susceptibility to an infectious agent
depends on an individual’s degree of resistance to pathogens

Risk factors that affect susceptiblility
age, nutritional status, presence of chronic disease, trauma, smoking, stress, disease process and a person’s natural defenses against infection

Stages of infection
incubation period, prodromal stage, illness stage, and convalescence

Incubation period
Interval between entrance of pathogen into body and appearance of first symptoms (e.g., chickenpox, 14 to 16 days after exposure; common cold, 1 to 2 days; influenza, 1 to 4 days; measles, 10 to 12 days; mumps, 16 to 18 days; Ebola 2 to 21 days)

Prodromal stage
interval from onset of nonspecific signs and symptoms (malaise, low-grade fever, fatigue) to more specific symptoms. (During this time microorganisms grow and multiply, and patient may be capable of spreading disease to others.) For example, herpes simplex begins with itching and tingling at the site before the lesion appears.

Illness stage
interval when patient manifests signs and symptoms specific to type of infection. For example, strep throat is manifested by sore throat, pain, and swelling; mumps is manifested by high fever, parotid and salivary gland swelling.

interval when acute symptoms of infection disappear. (Length of recovery depends on severity of infection and patient’s host resistance; recovery may take several days to months.)

localized infection (ex. wound infection)
a patient usually experiences symptoms such as pain, tenderness, warmth, and redness at the wound site. Use standard precautions, appropriate PPE, and hand hygiene when assessing the wound. Most common in areas of skin or mucous membrane breakdown such as surgical and traumatic wounds, pressure ulcers, oral lesions, and abscesses.

Systemic infection
an infection that affects the entire body instead of just a single organ or part and can become fatal if undetected and untreated.

Supportive therapy
includes providing adequate nutrition and rest to bolster defenses of the body against the infectious process

Nonspecific defenses
examples are normal floras, body system defenses, and inflammation. These protect against microorganisms regardless of prior exposure. If any of these body defenses fail, an infection usually occurs and leads to a serious health problem.

Normal flora
microorganisms that reside on the surface and deep layers of skin, in the saliva and oral mucosa, and in the GI and GU tracts. They do not usually cause disease when residing in their usual area of the body but instead participate in maintaining health..

develops when broad-spectrum antibiotics eliminate a wide range of normal flora organisms, not just those causing infection. When normal bacterial floras are eliminated, body defenses are reduced, which allows disease-producing microorganisms to multiply, causing illness.

Examples of body system defenses
skin, mouth, eye, respiratory tract, urinary tract, gastrointestinal tract, and vagina

the cellular response of the body to injury, infection, or irritation. It is a protective vascular reaction that delivers fluid, blood products, and nutrients to an area of injury. The process neutralizes and eliminates pathogens or dead (necrotic) tissues and establishes a means of repairing body cells and tissues.

Signs of localized inflammation
swelling, redness, heat, pain or tenderness, and loss of function in the affected body part

Signs of systemic inflammation
fever, increased white blood cells (WBCs), malaise, anorexia, nausea, vomiting, lymph node enlargement, or organ failure

Trigger inflammatory response
physical agents, chemical agents, or microorganisms

Examples of physical agents
mechanical trauma, temperature extremes, and radiation

Examples of chemical agents
external and internal irritants such as harsh poisons or gastric acid

Inflammatory response
vascular and cellular responses, formation of inflammatory exudates (fluid and cells that are discharged from cells or blood vessels [e.g., pus or serum]), and tissue repair

accumulation of fluid appears as localized swelling

process that involves the destruction and absorption of bacteria by neutrophils and macrophages

Nursing diagnosis (that deal with infection and inflammation)
risk for infection, imbalanced nutrition: less than body requirements, impaired oral mucous membrane, risk for impaired skin integrity, social isolation, and impaired tissue integrity

Common goals of care (applicable to patients with infection)
preventing further exposure to infectious organisms, controlling or reducing the extent of infection, maintaining resistance to infection, and verbalizing understanding of infection prevention and control techniques (e.g., hand hygiene)

Implementation for infection
handwashing and gloves, teaching good hygiene practices, maintain skin integrity, provide adequate nutrition, provide fluids to keep well-hydrated, provide adequate rest/sleep, administer antibiotics on time, instruct patient about antibiotics, and monitor patient for complications of infection

describes a process that eliminates many or all microorganisms, with the exception of bacterial spores, from inanimate objects

Types of disinfection
the disinfection of surfaces, and high-level disinfection, which is required for some patient care items such as endoscopes and bronchoscopes

eliminates or destroys all forms of microbial life, including spores. Methods include processing items using steam, dry heat, hydrogen peroxide plasma, or ethylene oxide (ETO).

Standard precautions
prevents and controls infection transmission. They apply to contact with blood, body fluid, nonintact skin, and mucous membranes from all patients.

Conditions for airborne precautions (droplet nuclei smaller than 5 microns)
measles, chickenpox (varicella), disseminated varicella zoster, pulmonary or laryngeal tuberculosis

Barrier protection for airborne
private room, negative-pressure airflow of at least 6 to 12 exchanges per hour via high-efficiency particulate air (HEPA) filtration; mask or respiratory protection device, N95 respirator (depending on condition)

Conditions for droplet precautions (droplets larger than 5 microns; being within 3 feet of the patient)
diphtheria (pharyngeal), rubella, streptococcal pharyngitis, pneumonia or scarlet fever in infants and young children, pertussis, mumps, Mycoplasma pneumonia, meningococcal pneumonia or sepsis, pneumonic plague

Barrier protection for droplet
private room or cohort patients; mask or respirator required (depending on condition) (refer to agency policy)

Conditions for contact precautions (direct patient or environmental contact)
colonization or infection with multidrug-resistant organisms such as VRE and MRSA, Clostridium difficile, shigella, and other enteric pathogens; major wound infections; herpes simplex; scabies; varicella zoster (disseminated); respiratory syncytial virus in infants, young children, or immunocompromised adults

Barrier protection for contact
private room or cohort patients (see agency policy), gloves, gowns (Patients may leave their room for procedures or therapy if infectious material is contained or covered, placed in a clean gown, and if hands are cleaned.)

Conditions for protective environment
allogeneic hematopoietic stem cell transplants

Barrier protection for protective environment
private room; positive airflow with 12 or more air exchanges per hour; HEPA filtration for incoming air; mask to be worn by patient when out of room during times of construction in area

Types of transmission-based precautions (based on mode of transmission)
Airborne, Droplet, Contact, and Protective Environment Precautions

Surgical asepsis
prevents contamination of an open wound, serves to isolate an operative area from the unsterile environment, and maintains a sterile field for surgery. Includes procedures used to eliminate all microorganisms, including pathogens and spores, from an object or area.

When to use surgical asepsis
during procedures that require intentional perforation of the patient’s skin, such as insertion of peripheral IV catheters or a central intravenous line, when the integrity of the skin is broken as a result of trauma, surgical incision, or burns, and during procedures that involve invasive procedures such as insertion of a urinary catheter or surgical instruments into sterile body cavities such as insertion of a wound drain

Where to use surgical asepsis
operating room, labor and delivery area, major diagnostic areas, and at the patient’s bedside (e.g., when inserting IV or urinary catheters, suctioning the tracheobronchial airway, and sterile dressing changes)

Principles of surgical asespis
1. A sterile object remains sterile only when touched by another sterile object. 2. Only sterile objects may be placed on a sterile field. 3. A sterile object or field out of the range of vision or an object held below a person’s waist is contaminated. 4. A sterile object or field becomes contaminated by prolonged exposure to air. 5. When a sterile surface comes in contact with a wet, contaminated surface, the sterile object or field becomes contaminated by capillary action. 6. When a sterile surface comes in contact with a wet, contaminated surface, the sterile object or field becomes contaminated by capillary action. 7. The edges of a sterile field or container are considered to be contaminated.

Order to put on PPE
gown, mask, goggles, and gloves

Order to take off PPE
gloves, face-shield/goggles, gown, and mask

infections most commonly transmitted by contaminated needles

disease producing organism

may be opportunistic

Contains no flora
blood, spinal fluid, and urine in kidneys/bladder

Examples of super bugs
MRSA, VRE, C-difficile, H1N1, and ebola

Acute infections
examples are appendicitis, URI, cold, etc.

Chronic infections
examples are HIV, Hepatitis C, AIDS, etc.

Cardinal signs of inflammation
redness, heat, swelling, and pain

how to treat inflammation (rest, ice, compression, elevation)

Steps of inflammation
Injury, cells release chemical mediators, vasodilation (increased blood flow), increased capillary permeability, leukocytes move to site of injury, and phagocytosis (removal of debris in preparation for healing)

Cellular immunity
develops when T lymphocytes with protein receptors on the cell surface recognize antigens on the surface of target cells and directly destroy the invading antigens. Immune response that does NOT involve antibodies, but rather involves activation of phagocytes, antigen-specific cytotoxic T lymphocytes, and release of various cytokines in response to an antigen.

Humoral immunity
aspect of immunity that is mediated by macromolecules found in extracellular fluids such as secreted antibodies, complement proteins, and certain antimicrobial peptides. Responsible by B lymphocytes or B cells.

IgM, IgG, IgA, IgD, and IgE
types of antibodies and immunoglobins

most common antibody in the blood; produced in both primary and secondary immune responses; activates complement; includes antibacterial, antiviral, and antitoxin antibodies. Crosses placenta, creates passive immunity in newborn.

Natural killer cells
are lymphocytes distinct from the T and B lymphocytes. They destroy, without any prior exposure and sensitization, tumor cells and cells infected with viruses.

Bound to B lymphocytes in circulation and is usually the first to increase in the immune response; activates complement; forms natural antibodies; is involved in blood ABO type incompatibility reaction.

found in secretions such as tears and saliva, in mucous membranes, and in colostrum to provide protection for newborn child.

binds to mast cells in skin and mucous membranes; when linked to allergen, causes release of histamine and other chemicals, resulting in inflammation.

attached to B cells; activates B cells

Active immunity
due to antigen, long term, natural (infection, contact with pathogen) and artificial (vaccine, dead or attenuated pathogens)

Passive immunity
antibodies given, short duration, natural (antibodies pass from mother to fetus thru placenta or to infant in her milk) and artificial (injection of immune serum: gamma globulin)

Inappropriate immune response
allergy and anaphylaxis, cytotoxic hypersensitivity, immune complex hypersensitivity, cell-mediated or delayed, and auto immune

Respiratory infection (clinical appearance)
sore throat, stuffy/runny nose, and cough

Urinary infection (clinical appearance)
frequency, dysuria, cloudy or discolored urine

Skin/MM infection (clinical appearance)
redness, swelling, pain, localized warmth, loss of function

Systemic infection (clinical appearance)
febrile, inc pulse and respirations, malaise, loss of energy, anorexia, nausea and vomiting, enlarged and tender lymph nodes

nonspecific agents that protect uninfected cells against viruses (they are a protein)

a localized pocket of purulent exudate or pus in a solid tissue (e.g., around a tooth or in the brain)

Leukocytosis (lab test results)
increased white blood cells in the blood, elevated serum C-reactive protein (CRP), an elevated erythrocyte sedimentation rate or ESR, and increased plasma proteins and cell enzymes in the serum are nonspecific changes

Differential count
the proportion of each type of WBC, may be helpful in distinguishing viral from bacterial infection

Increase in protein synthesis
increased circulating plasma proteins (fibrinogen, prothrombin, and alpha-antitrypsin) caused by hepatocytes

Isoenzymes (cell enzymes)
may be elevated in the blood in the presence of severe inflammation and necrosis. These may be helpful in locating the site of the necrotic cells that have released the enzymes into tissue fluids and blood.

AST (Aspartate aminotransferase)
is elevated in liver disease and in the acute stage of a myocardial infarction (heart attack)

Isoenzyme CK-MB (isoenzyme of creatine kinase with myocardial component)
is specific for myocardial infarction

ALT (enzyme alanine aminotransferase)
is specific for the liver

Local complications
depend on the site of inflammation. For example, inflammation in the lungs may impair the expansion of the lungs, decreasing the diffusion of oxygen. Inflammation of a joint may affect its range of movement.

may develop in an inflamed tissue because microorganisms can more easily penetrate when the skin or mucosa is damaged and the blood supply is impaired

Skeletal muscle spasms
strong muscle contractions may be initiated by inflammation resulting from musculoskeletal injuries such as sprains, tendinitis, or fractures

Chronic inflammation
may develop following an acute episode of inflammation when the cause is not completely eradicated. Or inflammation may develop insidiously owing to chronic irritation such as smoking, certain bacteria, or long-term abnormal immune responses.

a reduction in the number of leukocytes in the blood, often caused by viral infections

growth of microorganisms on a specific nutritious medium in a laboratory

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