infection control

Passive immunity

short duration (days to months) by natural transplacental transfer from mom or artificially by injection of antibodies (immunoglobulin)

Contact precautions

1. private room preferred. if not, cohort with patient with same active infection with same microorganisms if no other infection present. 2. wear gloves when entering. 3. hand hygiene with antibacterial soap when leaving room. 4. were gown to prevent contact with patient or contaminated items; remove before leaving room. 5. dedicated equipment to patient only (disinfect after use before taking out of room). Ex of diseases: c.diff, MRSA, VRE, Pediculosis, RSV, Scabies, Ebola.

Airborne precautions

1. private room with negative airflow; keep doors closed. 2. N95 masks for known suspected TB. susceptible persons not to enter room of patient with known or suspected measles or varicella unless immune caregivers aren't available. 3.patient wears surgical mask when transported. EX of disease: measles (rubeola), mycobacterium TB, varicella (chickenpox); disseminated zoster (shingles)

Measles (Rubeola)

AIRBORNE PRECAUTIONS s/s appear 10 - 12 days after exposure to virus. precautions- 4 days after onset of rash. only immune by vaccine or that's had measles before should room together or should care for a patient with measles. unimmune and exposed to measles give vaccine within 72 hr or iG within 6 days when available exclude HCW's from duty from day 5 after first exposure to day 21 after last exposure- regardless from person to person

Varicella Zoster (chicken pox)

AIRBORNE/CONTACT/STANDARD only immune caregivers should provide care airborne/contact until lesions are dry/crusted post exposure- give vaccine asap/within 120 hours if vaccine is contraindicated- use VZIG airborne precautions for exposed unimmune HCW's beginning 8 days after first exposure till 21 days after last exposure or 28 if received VZIG, regardless of post exposure vaccine.

Patient placement CDC

CDC recommends private room always for airborne and those in a protective environment (PE). PE designed to prevent infection from occurring in patients who are at extreme high risk- EX: stem cell therapy.

RSV

CONTACT wear mask according to standard precautions immunocompromised- extend the duration of contact precautions d/t prolonged shedding.

Rotavirus

CONTACT PRECAUTION causes severe diarrhea, common in infants and children and also among elderly in group settings like NH. most common cause of gastroenteritis. transmitted fecal-oral route. incubation 48 hr. consistent environmental cleaning and disinfection and frequent removal of soiled diapers. prolonged shedding may occur in immunocompromised and immunocompetent children and elderly. Don't use anti diarrhea medication d/t will slow motility, causing decreased shedding (they need to shed the virus out) Don't return to daycare until diarrhea stopped.

Clostridium Difficile Iggy pg 449

CONTACT PRECAUTION - spread by indirect contact with inanimate objects (commodes, bp cuff, stethoscope). is associated with abx use especially in elderly. throw away utensils while at hospital D/C ABX if appropriate Don't share electric thermometers Throw away gown and gloves before leaving room. Leave stethoscope, bp device in room. Hypochlorite solutions to clean- 1/2 bleach mix Soap and water hand hygiene d/t its a spore! What goes in the room stays in the room

Congenital Rubella

CONTACT PRECAUTIONS until 1 y/o. STANDARD PRECAUTIONS of nasopharyngeal and urine cultures repeatedly negative after 3 months of age.

Diphtheria

CONTACT PRECAUTIONS- cutaneous until 2 cultures taken 24 hr apart are negative DROPLET PRECAUTIONS- pharyngeal until 2 cultures taken 2 hr apart and are negative Diphtheria can cause pharyngitis (sore throat)

Influenza

DROPLET PRECAUTIONS Duration 5 days except if immunocompormised- this can cause a longer duration single patient room or cohort with other respiratpry illnesses; avoiding placing with high risk patient. isolation until at least 24 hy after fever is gone without meds mask for transport use gown and gloves and mask when entering room and remove them before walking out the door respiratory droplets fall 3 - 6 fr (or up to 10 ft) from person after coughing, sneezing or talking. droplets can be picked up from surfaces and indirectly spread to mucus membranes after touching contaminated surfaces. follow airborne precautions during aerosol-generating procedures like bronchoscopy, intubation, CPR, open airway suctioning, and sputum induction.

Rubella (german measles)

DROPLET PRECAUTIONS until 7 days after onset of rash unimmune HCW do not care for patient and don't room this patient with unimmune patients if pregnant and unimmune don't care for patient to care for this patient you have to have had vaccine or have had the disease before give vaccine within 3 days of exposure to NONpregnant unimmune HCW's Exclude HCW from day 5 of first and day 21 after last exposure regardless of post exposure vaccine

Meningococcal meningitis

DROPLET until 24 hr after starting abx medical emergency. high mortality rate within 24 hr. the only type that occurs in outbreaks, most likely to occur in high population density like college dorms, military, crowded living areas. also affects compromised immune systems and those with spleen damage or no spleen. meningitis is inflammation of meninges surrounding the brain and spinal cord. bacterial or viral organisms are most often the cause.

Abscesses

Major draining and no dressing or containment of drainage use contact precautions until wound stops draining Minor or limited draining with dressing covers and contains drainage use standard precautions

Salmonella and Shigella

STANDARD PERCAUTIONS if continent CONTACT PRECAUTIONS if incontinent or diapered Teach handwashing don't go to daycare while bacteria is shedding (diarrhea) don't take anti diarrheal- need to shed the bacteria Salmonella- bacterial infection caused by contaminated food or drink, can be transmitted by fecal-oral route. s/s fever, n/v, and cramps, and diarrhea lasting 3 - 5 days. transmitted by 5 f's- flies, fingers, food, feces, and fomites. Shigella- transmitted direct or indirect fecal-oral route. communicable during acute illness to 4 wk after illness. humans can possibly carry for months.

Herpes Zoster- Shingles

STANDARD PRECAUTION cant be passed from one person to another. virus that causes shingles can cause chickenpox in someone who is unimmune through touching the rash. common in people > 50 anyone who has had chicken pox can develop shingles -if never had chicken pox don't room them with someone who has shingles or don't assign that nurse to a patient with shingles- zoster (shingles)- reactivation of varicella zoster virus in patients who have previously had chickenpox, virus lays dormant in dorsal root ganglia of the sensory nerve.

Hepatitis A

STANDARD PRECAUTION if continent CONTACT PRECAUTIONS if incontinent or diapered hardy virus that survives on humans hands. resistant to detergents and acids but killed by chlorine (bleach) and extreme high temps. spread fecal-oral route by person to person or contaminated food or water. similar of flu like s/s and GI illness. teach don't prepare food while ill teach handwashing hep A vaccine post exposure to exposed contacts Hep A iG offered to close contacts of patient for 1 month after s/s and 2 weeks for other contacts. iG is weight based, give hep a and iG in different arms. Im injection. iG good for 3 months.

Hepatitis B and C

STANDARD PRECAUTIONS transferred through blood and body fluids Hep B-- spread through blood transfusion, needle sticks, dialysis, maternal-fetal, unprotected sex. s/s- anorexia, n/v, fever, tired, joint pain, RUQ pain, light stool dark urine, jaundice. Hep C- transmitted blood-blood. IV drug use, blood products or organ transplants before 1992, need stick, dirty tattoo, intranasal cocaine paraphernalia sharing. don't share razors, toothbrush, or earrings d/t microscopic blood may be on this item.

Haemophilus influenza - type b (HIB)

STANDARD- adults DROPLET- children until 24 hr after starting abx don't give this vaccine past age 5- usually will have atleast 4 shots. HIB is given to prevent meningitis if at risk for the flu and pneumonia need to have the vaccines.

Botulism

Standard precautions- this is not transmitted person to person

Standard precautions

all body fluids, and moist membranes and tissues excluding perspiration are potentially infectious. Use universal precautions. also use respiratory hygiene/cough etiquette (RH/CE) is now required d/t SARS outbreak in 2003.

HIV pg 358

cause is a virus. progresses into AIDs. everyone who has AIDs had HIV but not everyone with HIV has AIDs. CD4+ T-cells are reduced in HIV. Viral numbers (viral load) rises and w/o tx the person dies from opportunistic infections (caused by organisms that are present as part of the body's normal environment. they occur d/t the immunosuppression with AIDs) or cancer. develop acute infection in about 4 weeks. fever, night sweats, chills, HA, muscle aches. rash, sore throat. to have AIDs have to be dx with HIV +, and either CD4 T-cell of < 200 or opportunistic infection. once dx even if CD4 rises about 200 or infection is successfully tx the AIDs dx remains and patient never goes back to just being HIV+.

Needles and other sharps

don't recap, bend, break or hand manipulate used needles; if you have to recap use one handed scoop.

PPE- Gown

during procedures and patient care activities when contact of clothing/exposed skin with blood/body fluids, secretions, and excretions is anticipated.

Droplet transmission

for patients known or suspected to have infections spread through droplets. these are caused by organisms in droplets that may travel 3 ft but are not in air for long periods of time. EX: flu, mumps, pertussis, meningitis caused by n.meningitides or haemophilus influzenzae type b. Don a mask when within 6 ft - 10 ft of patient or upon entry into patients room.

Contact Transmission

for patients known or suspected to have infections transmitted by direct contact or contact with items from the environment. who subgroups of contact precaution- direct and indirect

Cohorting

grouping patients who are colonized or infected with same pathogen. used mostly with patients who have outbreak of MRSA.

Immunizations

help build protection against some infections.

TB pg 653

highly communicable disease d/t mycobacterium tuberculosis. transmitted aerosolization (airborne). when person with active TB cough, laughs, sneezes, whistles, or sings droplets become airborne and my be inhaled by others only small % of people infected with TB actually become active. cell mediated immunity develops in about 2 - 10 weeks causing a positive tb skin test. its a nonmoving, slow growing, acid fast rod. risk for spread is reduced after infectious person receives meds for 2 - 3 wks. at greatest risk- frequent constant contact w/ infected person. decreased immune or HIV, live in crowded areas (NH, prisons), older homeless, abusers of alcohol and drugs, lower socioeconomic, foreign immigrants (Mexico, Philippines, Vietnam). consider TB is have persistent cough, wt loss, anorexia, night sweats, sob, fever, or chills, sputum with blood. BCG caused positive tb skin test.

Patient placement

its a way to reduce spread of infection. private rooms help decrease infection. put everyone in private room if possible. if private isn't available, place them in room with other who is colonized or infected with the same organism, but doesn't have other infections (cohorting). or can place patient with other who doesn't have risk factors for infection.

Active immunity

lasts for years and is natural by infection or artificial by stimulation of the bodies immune defense (vaccination)

Colonization

microorganisms are often pathogenic may be present in the tissues of the host and yet not cause symptomatic disease because of normal flora. Its present in the body but not causing illness.

Airborne transmission

occurs by dissemination of airborne droplet nuclei or small particles in the respirable size range containing infectious agents that remain infective over time and distance. special handling and ventilation systems to contain and then safely remove the infectious agent.

Direct contact transmission

occurs when microorganism are transferred from one infected person to another without contaminated intermediate object or person. EX: blood or blood containing body fluids from patient directly enters caregivers body through contact with mucous membranes.

Placing patient in rooms

prioritize for single patient room if increased risk for transmission, is likely to contaminate environment, doesn't maintain hygiene or is at increased risk for infection or developing adverse outcome following infection

Droplet precautions

private room; if not cohort with same active infection with same microorganisms if no other infection present; keep distance at least 3 ft from other patients if sharing room. mask: required if working within 3 ft. EX of diseases: diphtheria (pharyngeal), strep pharyngeal, pneumonia, flu, rubella, invasive disease (meninigitis, pneumonia, sepsis) d/t haemophilus flu type b or Neisseria meningitides, mumps or pertussis.

Hand hygiene

recommended after body fluids, blood, secretions, excretions, contaminated items, immediately after removing gloves and in between patient contact.

PPE- Gloves

recommended for touching blood, body fluids, secretions, excretions, contaminated items, for touching mucous membranes and nonintact skin.

RH/CE

required for patients and visitors with signs of respiratory illness, like congestion, cough, or rhinorrhea (runny nose). -give education -post signs -hand hygiene -cover nose/mouth with tissue and dispose tissue quickly or use mask (or sneeze/cough in shirt sleeve rather than hand) - separate from the person with respiratory infection more than 3 feet.

HIV

standard precautions unless something is draining

Respiratory hygiene/ cough etiquette

symptomatic person to cover mouth/nose when cough/sneeze; use tissues and dispose to no-touch receptacle; observe hand hygiene after soiling hands with secretions; wear surgical mask if tolerated or maintain space > 3 ft if possible.

Infection

the organism is present and is causing illness.

Indirect contact transmission

transfer of infectious agent through a contaminated intermediate object or person. EX: toys, patient care devices that's shared, instruments that are not cleaned properly between patients (BP cuff, stethoscope)

Spore containing power

wash hands with soap and water for 30 - 60 seconds with 2% chlorhexidene after spore contact. don't just use alcohol based hand cleaners- these are inactive against spores!

PPE- Mask, goggles, face shield

when likely to splash or spray of blood, body fluid, secretion, especially suctioning, and endotracheal intubation.