Integumentary system and Infection control

Healthcare acquired infection

"Nosocomial" Originating in hospital NOT PRESENT ON ADMISSION

Vancomycin- resistant enterococcus

"VRE" Enterococcus normally found in intestines; Becomes resistant Found in body fluids, secretions, and wounds Reservoir is the rectum Transmission = Hands and Objects

Other interventions to eliminate reservoirs

- Changing dressings and bandages when soiled - Appropriate skin and oral hygiene - Disposing of damp, soiled linens appropriately - Disposing of feces and urine in appropriate receptacles - Ensuring that all fluid containers are covered or capped - Emptying suction and drainage bottles at end of each shift or before full or according to agency policy

Interventions against etiologic agents

Cleaning, disinfecting or sterilizing articles Vaccines, antibiotics, antivirals, radiation (UV) Educating public, patients, and families Public Health regulations and enforcement

People at risk

Diagnostic or therapeutic procedures Lifestyle Compromised host Insufficient hand hygiene

Portal of entry

Often the same as the route from the reservoir Sputum to Upper Respiratory Tract Blood to Blood or Mucous Membranes Urinary, respiratory, GI, skin are most common

Portal of exit interventions

- Avoiding talking, coughing, or sneezing over open wounds or sterile fields - Elbow coughing or sneezing - Teaching proper toileting procedures - Appropriately cleaning incontinent patients - Proper surgical aseptic technique and precautions per - CDC guidelines

Etiologic Agents

- Bacteria - Viruses - Fungi - Parasites

Normal flora

- Bacteria on our bodies that doesn't cause disease

Angiomas (hemangiomas)

- Benign vascular tumors with dilated blood vessels

Nursing diagnosis

Risk for infection Risk for infection transmission Risk for imbalanced body temperature Risk for complications Knowledge deficit Body image disturbance Social Isolation

TB Precautions

Airborne Precautions Respiratory Mask (Fitted properly) Negative Pressure Room Gowns

Developmental considerations

- Infant's skin and mucous membranes are easily injured and subject to infection. - A child's skin becomes increasingly resistant to injury and infection. - The structure of the skin changes as a person ages. - As one ages the maturation of epidermal cells is prolonged, leading to thin, easily damaged skin.

Airborne

- Infection that spreads through the air - In a negative pressure room - pt needs to be transported out of room

Systemic infection

- Infection where pathogen effects the whole body - S/S will vary depending on host and infection factors - Possible Sign and Symptoms - Fever - Malaise - Anorexia, N/V - Enlarged Lymph Nodes - Elevated Pulse and Respiratory Rate

Examples of a localized function

- Insect bites - Pressure ulcers - Cuts - Burns - acne - poison ivy - warts - phlebitis

Body's defense against infection

- Intact skin and mucous membranes - Moist mucous membranes and cilia of the nasal passages - Alveolar macrophages - Tears - High acidity of the stomach - Resident flora of the large intestine - Peristalsis - Low pH of the vagina - Urine flow through the urethra

Clean technique

- Limits the number, growth, and transmission of microorganisms - Includes all practices intended to confine a specific microorganism to a specific area - Objects referred to as clean or dirty (soiled, contaminated) - How can we promote Medical Asepsis?

Managing equipment

- Many supplied for single use only - Disposed of after use - Agencies have specific policies and procedures for handling soiled reusable equipment - Nurses need to become familiar with these practices

Factors Affecting an Organism's Potential to Produce Disease

- Number of organisms - Virulence (microorganism causing disease) - Competence of person's immune system - Length and intimacy of contact between person and microorganism

Use of surgical asepsis

- Operating room, labor and delivery areas - Certain diagnostic testing areas - Patient bedside - For example, for procedures that involve insertion of urinary catheter, sterile dressing changes, or preparing and injecting medicine

Possible reservoirs for microorganisms

- Other humans - Animals - Soil - Food, water, milk - Inanimate objects

C- diff treatment

- Positive stool culture to confirm (Need 3 Neg. to r/o) - Change in antibiotic therapy - Probiotics - Hydration - Correct electrolyte disturbances - Meticulous skin care - NO NARCOTICS IF POSSIBLE

Answer

B

Skin care

Bathe daily non-drying soap Remove any pustules or crusts gently. Avoid excessive moisture. Ensure optimal patient positioning.

Seborrheic Keratosis

Benign plaques with velvety or warty surface

Community acquired infections

Infection acquired from the community or an infection present on admission - Examples: influenza, pneumonia

Parasites

Live on or in a host, rely on it for nourishment

Lentigo

Liver spots

Organisms requiring isolation

MRSA (Methicillin Resistant Staph Aureus) VRE (Vancomycin Resistant Enterococcus) C- Difficile Tuberculosis Influenza

Bacteria

Most significant and most prevalent in hospital settings

Tips for maintaining sterile technique

Only STERILE can touch STERILE Hold objects at waist level, away from body Avoid talking, coughing, sneezing NEVER turn your back on sterile items NEVER reach over sterile field **LEARN HOW TO DON STERILE GLOVES

Interventions to prevent transmission

Hand Hygiene, Hand Hygiene, Hand Hygiene!!! Transmission Precautions IN ADDITION TO STANDARD PRECAUTIONS Education of public & healthcare personnel

Signs and symptoms of infection

Remember: Older adults have reduced inflammatory and immune response- may not present with same s/s of illness as a younger person Agitation Confusion Incontinence

Evaluating patient goals

Use techniques of medical asepsis. Identify health habits and lifestyle patterns promoting health. State signs and symptoms of an infection. Identify unsafe situations in the home environment.

Methods of transmission

- Hands/contact directly or via inanimate objects - Droplets (cough or sneeze) - Sexual contact - Food - Vectors - Invasive procedures

Asepsis includes

- Handwashing - If needed -Donning and Removing PPE - Preparing/Maintaining a Sterile Field - Applying Sterile Gloves - Disposal of equipment

Inflammatory response

- Help controls and eliminates agents

Factors influencing HAI

Adequate staffing Sterilization Disinfection Aseptic Technique Patient placement: Cohorting Patient transportation

Endogenous

- Already in one's body - TB

Medical asepsis

- Clean technique

Interventions to eliminate reservoirs

- Clean water - Safe waste/water treatment and disposal - Safe food production and handling procedures - Eliminate standing water during high risk times - Cleaning hands before eating & after toileting - Vaccines

Clostridium difficile

- Colonized in the intestinal tract occurs when normal flora is disrupted by antibiotic therapy. - Sufficient toxin production is needed to produce disease - Major cause of nosocomial diarrhea - Most common infectious cause of diarrhea in LTC - Transmission = Fecal-Oral

C- Diff precautions

- Contact Isolation (protects others) - Door open - Gloves always - Disinfect equipment - Gown when in contact with patient or immediate surroundings - Visitors: No special precautions; Wash hands when leaving; Monitor children **Alcohol based hand sanitizers Do not kill c-diff spores!!! ** spores can live on surfaces for up to 5 months

MRSA Precautions

- Contact Isolation (protects others) - Door open - Gloves always - Mask when in the nares/sputum - Disinfect equipment - Gown when in contact with patient or immediate surroundings - Visitors: No special precautions; Wash hands when leaving; Monitor children - MRSA can colonize and stay on the skin and remain harmless

VRE Precautions

- Contact Isolation (protects others) - Door open - Gloves always - Mask when in the nares/sputum - Disinfect equipment - Gown when in contact with patient or immediate surroundings - Visitors: No special precautions; Wash hands when leaving; Monitor children - VRE can live 72 hours on inanimate objects

Immune response

- Defends itself against foreign agents

Prodromal stage

- Early, vague signs and symptoms - Unaware that they are really sick

Lab data indicating infection

- Elevated white blood cell count—normal is 5,000 to 10,000/mm3 - Increase in specific types of white blood cells - Elevated erythrocyte sedimentation rate (ESR) - Presence of pathogen in urine, blood, sputum, or draining cultures

Functions of the skin

- Protection - Body temperature regulation - Psychosocial - Sensation - Vitamin D production - Immunological - Absorption - Elimination

The inflammatory response

- Protective mechanism that eliminates the invading pathogen and allows for tissue repair to occur - Vascular & cellular responses - Cardinal signs: redness, heat, swelling, pain, & loss of function - Histamine, blood flow, leukocytes (neutrophils & phagocytes)

Droplet

- Pt needs to wear mask always

Convalescent period

- Recovery period

Common portals of exit

- Respiratory - Gastrointestinal - Genitourinary tracts - Breaks in skin - Blood and tissue

Iatrogenic

- Results from a treatment

Skin tags

- Soft brown or flesh colored benign papules

Full stage of illness

- Specific signs and symptoms

Current CDC guidelines

- Standard precautions—used in care of all hospitalized patients - Apply to blood, body fluids, secretions, excretions, nonintact skin, mucous membranes - Transmission-based precautions—used in addition to standard precautions for patients with suspected infection - Include airborne, droplet, or contact precautions

Surgical asepsis

- Sterile technique

Sterile technique

- Sterile technique - Practices that keep an area or object free of all microorganisms - Practices that destroy all microorganisms and spores - Used for all procedures involving sterile areas of the body - How can we promote Surgical Asepsis?

Localized infection

- Swelling - Redness - Pain/ tenderness with palpation and movement - heat - can possibly lose function

Incubation period

- Time when pathogen invades body to first signs and symptoms

Contact

- Touching - MRSA - C- diff - Wearing gown, gloves and removing it all before you leave room - avoid sharing equipment - Supplies should already be in room

Factors affecting the skin

- Unbroken and healthy skin and mucous membranes defend against harmful agents. - Resistance to injury is affected by age, amount of underlying tissues, and illness. - Adequately nourished and hydrated body cells are resistant to injury. - Adequate circulation is necessary to maintain cell life.

Prevention of portal of entry

- Using sterile technique for invasive procedures, when exposing open wounds or handling dressings - Placing used disposable needles and syringes in puncture-resistant containers for disposal - Providing all clients with own personal care items - Thorough and appropriate terminal cleaning

Causes of skin alterations

- Very thin and very obese people are more susceptible to skin injury. - Fluid loss during illness causes dehydration. - Skin appears loose and flabby. - Excessive perspiration during illness predisposes skin to breakdown. - Jaundice causes yellowish, itchy skin. - Diseases of the skin cause lesions that require care.

Exogenous

- When infection is acquired from other people

In which of the following stages of infection is the patient most contagious?

A. Incubation period B. Prodromal stage C. Full stage of illness D. Convalescent period

Exposure

Actual pathogen

MRSA

Can be colonized on the skin Found in body fluids, secretions, wounds Nose serves as reservoir Transmission = hands, contact

The chain of infection: Means of transmission

Etiologic Agent (microorganism) Reservoir (source) Portal of Exit (from reservoir) Method of Transmission Portal of Entry to the susceptible host Host Susceptibility

Risk assessment

History: Hygiene and lifestyle practices Immunocompromised Recent surgery Indwelling devices Skin breaks Poor oxygenation status Impaired circulation Chronic diseases: DM, endocrine, renal, liver, lung disease Age

More interventions

Holding used bedpans steadily to prevent spillage Disposing of urine and feces appropriately Initiating and implementing aseptic precautions (standard precautions) for all clients Placing discarded soiled materials in moisture-proof refuse bags Implementation of IHI "Bundles" against CAUTI, CLABSI, VAP, etc.

Aseptic technique

Includes all activities to prevent or break the chain of infection

Fungi

Plantlike organisms present in air, soil, and water

Treating MRSA

Positive culture = Diagnosis Active infection and/or colonization requires isolation and medication Surveillance for exposure/colonization Need negative culture x3 to rule out

VRE Treatment

Positive culture = Diagnosis Active infection and/or colonization requires isolation and medication Surveillance for exposure/colonization Need negative rectal/source culture x3 to rule out

Virus

Smallest of all microorganisms

Classification of bacteria

Spherical (cocci), rod shaped (bacilli), corkscrew shaped (spirochetes) Gram positive or gram negative—based on reaction to Gram stain Aerobic or anaerobic—based on need for oxygen

Planning/ interventions

The nurse's role in breaking the cycle of infection