Infection

What is a normal WBC in an adult?

5,000 to 10,000 but will typically rise to 15,000-20,000 when inflammation is present

What pH do most microbes prefer?

5.0-7.0 (bacteria thrive in urine with an alkaline pH)

How do we prevent infections?

By involving pts in self-care activities ad by nurses' actions to break chain-hand hygiene and standard precautions

T or F. Laboratory values are enough to detect infection.

FALSE. Contaminations are possible. You need to assess other clinical signs of infection

Corticosteroids and TNF (tumor necrosis factor) inhibitors are two medications that increase the chance of getting _____infection

Fungal

exposed skin and deep burns think

INFECTION

exposed skin and deep burns think

INFECTION moxifloxacin

What are major sites f HAIs?

Surgical or traumatic wounds, urinary and respiratory tracts, and the bloodstream

What happens during the illness stage of infection?

This is the stage where the pt manifestsS&S specific to the infection -this is also where systemic inflammatory response syndrome (SIMS) takes place

What is tier I and tier II with precautions?

Tier I are standard precautions and Tier II are transmission based

Where to microbes thrive?

Uncooked food, moist dark places

How do you get a fever?

Your hypothalamus (thermostat) sends message of phagocytic release of pyrogens from bacterial cells to raise temp in body

What is virulence?

ability to cause disease and thee susceptibility of the host

tuberculosis is spread through which correct method of transmission?

droplet and airborne

what is the most effective way to break the chain of infection and control the transmission of infection?

hand washing-vaccinations are an effective measure to PREVENT OCCURRENCE of infection of an individual

What is the infectious agent?

#1 in the chain of infection. This is the microorganism that can be a bacteria, virus, fungi, and Protozoa

What is a reservoir?

#2 in chain of infection. A place where microorganisms survive, multiply, and await transfer to a susceptible host -common are humans, animals, insects, food, water, inanimate objects (fomites)

What is the portal of exit?

#3 in chain of infection. The way/place a microbe finds a site to multiply and cause disease - these include sites like blood, skin, mucous membranes, respiratory tract, genitourinary tract, gastrointestinal tract, and transplacental tract

What is mode of transmission?

#4 in chain of infection. the way in which an agent travels from host to host -some microbes can be spread by more than one route (chicken pox can be spread. Via airborne, droplet, or contact) -Contact: direct, indirect, droplet, airborne -Vehicle: contaminated items, water, drugs, solutions, blood, food -vector: external mechanical transfer (flies), internal transmission like parasites (mosquito, louse, flea, tick)

What is the portal of entry?

#5 in chain of infection. sites through which pathogens enter the body-the same routes they us for exiting -ex: venipuncture when a needle pierces a pt's skin, organisms enter the body if proper skin prep is not performed first

What is a susceptible host?

#6 in the chain of infection. the last link in the chain of infection, is one whose biologic defense mechanisms are weakened in some way- depends on an individual's degree of resistance to pathogen -age, nutritional status, presence of chronic disease,, trauma, and smoking effect this

What are HAIs?

(Healthcare Associated Infections) These happen as result of invasive procedures, antibiotic administration, the presence of multi drug-resistant organisms (MDROs), and breaks in infection prevention and control activities -these also significantly increase the cost of healthcare (esp. in older adults w/ higher susceptibility to infections—> extended stays in hospital, increased disability, increased cost of antibiotics, and prolonged recovery times add to expenses of both the pt no the health care institution and funding bodies ) -TJC lists prevention for older adults to receive influenza and pneumonia vaccines

reservoir: plasmodium falciparum

(blood) causes malaria

reservoir: candida albicans

(the mouth, skin, colon, and genital tract) fungi that causes infections like pneumonia, candidiasis, and sepsis

reservoirsL: rickettsia rickettsii

(wood tick) causes rocky mountain spotted fever

What makes a disease symptomatic vs non-symptomatic?

-> symptomatic: if the pathogen multiplies and clinical signs and symptoms are present —> non: clinical signs and symptoms are not present

With nutritional status it is important to find...

-a thorough diet history -determine a pt's normal daily nutrient intake and whether preexisting probs such as nausea, impaired swallowing, or oral pain alter food intake -confer w a registered dietician to assist in calculating the calorie count of foods ingested

Once you have assessed your pt, you want to perform a physical assessment and get info on CLINICAL APPEARANCE by

-examining areas involved in n infection as well as areas where risk of infection exists (S&S may be localized or systemic) -To assess an area for localized infection, first inspect it for redness, warmth, and swelling caused by inflammation. Because there may be drainage from open lesions or wounds, wear clean gloves. Infected drainage may be yellow, green, or brown, depending on the pathogen. For example, green nasal secretions often indicate a sinus infection. Ask the patient about pain or tenderness around the site. Some patients experience tightness and pain caused by edema. If the infected area is large enough, movement is restricted. Gentle palpation of an infected area usually results in some degree of tenderness. Wear personal protective equipment (PPE), especially protective eyewear and a surgical mask, when there is a risk for splash or spray with blood or body fluids.

What risks for infection exist for older adults?

-functional deterioration of the immune system function, termed immune senescence, increased susceptibility, and slower immune response -less capable of producing lymphocytes-when antibodies are produced, thee duration of their response is shorter and fewer are produced -risks associated w HAIs are poor nutrition and unintentional weight loss, lack of exercise, poor social support, low serum albumin levels -flu and pneumonia vaccinations are recommended for older adults to reduce risk for infections -teach older adults and families how to reduce the risk for infection by using proper hand hygiene practices

What causes a higher risk for infection?

-population -environment -Age -chronic illness -nutrition deficit Stress

When performing your assessment on your pt, what information are you gathering?

-pt's current condition, any history of previous health probs involving infection, and potential risks posed in the pt's current environment -remember to apply knowledge of the infectious process, the pt's diagnosed medical probs, and your previous experience w patients w infection to focus on your physical examination -assess pt's knowledge of RISK FACTORS ( that increase the susceptibility for developing an infection to help plan appropriate pt education -ask about the pt's expectations of care and preferences and how they want to be involved in planning care

Possible nursing diagnoses:

-risk for infection -impaired nutritional status: deficient food intake -impaired oral mucous membranes -social isolation -impaired tissue integrity *once you identify nursing diagnosis, you an identify expected pt outcomes and select appropriate nursing interventions for the plan of care

Examples of expected outcomes to nursing diagnosis: Risk for infection:

-the pt demonstrates proper hand hygiene prior to discharge -the pt identifies the signs and symptoms of the wound infection -the pt is a febrile upon discharge -the pt's wound edges are approximated at time of discharge

What are the 6 components of the chain of infection?

1. Infectious agent or pathogen 2. Reservoir or source of pathogen growth 3. Portal of exit from the reservoir 4. Mode of transmission 5. Portal of entry 6. Susceptible host (Infection can develop if this chain remains uninterrupted)

which element is part of the chain of infection? 1. an infectious agent 2. a vaccine schedule 3. the source of pathogen growth 4. a clean surrounding 5. a susceptible host

1. an infectious agent 3. the source of pathogen growth (RESERVOIR) 5. a susceptible host

What temp do microbes usually thrive in?

20-43 C or 68-109 F

which source is a vehicle for infection transmission? 1. mosquitoes 2. flies 3. Intravenous (IV) fluid 4. food 5. water

3. Intravenous (IV) fluid 4. food 5. water *these help the microbes spread from one person to another-mosquitos and flies are vectors and can spread infection through external and internal transmission

What is phagocytosis and its function during inflammation?

A process that involves thee destruction and absorption of bacteria. Specialized WBCs called neutrophils and monocytes ingest and destroy microbes

Communicable disease is ...

An infectious disease that can be transmitted directly from one person to another

Why are pts with chronic diseases more susceptible to infection?

B/c general debilitation and nutritional impairment -bronchitis: impairs ciliary action and thicken mucus -cancer: alters immune response -peripheral vascular disease: reduces blood flow to injured tissues -burns: due to damage of skin (our 1st line of defense-innate immune system-the greater the depth, the greater the risk)

Systemic infections sometimes develop after treatment for localized infection has failed. What must you be alert for?

Be alert for changes in a patient's level of activity and responsiveness. As systemic infections develop, an elevation in body temperature can lead to episodes of increased heart and respiratory rates and low blood pressure. Involvement of major body systems produces specific symptoms. For example, a pulmonary infection results in a productive cough with purulent sputum. A UTI results in cloudy, foul-smelling urine.

What is the most effective way to break thee chain of infection?

HAND HYGIENE

What are ex of common localized infections?

In areas of skin or mucous membrane breakdown: surgical nd traumatic wounds, pressure injuries, oral lesions, and abscesses

What is the difference between infection and colonization?

Infection means that bacteria in or on your body make you sick/symptomatic (results when a pathogen invades tissues and begins growing within a host) Colonization means the germs are on the body but do not make you sick or cause symptoms (is the presence and growth o microbes w/in a host but w/out tissue invasion or damage)

The nurse needs to administer an injection to a patient. What precautions should the nurse take to prevent infection during injection administration

Injections cross the first line of defense of the body and may increase the risk of infection. To reduce the risk of infection, the tip of the syringe should be covered either with a cap or a needle. The skin should be cleaned in a circular motion with an antiseptic swab. This decreases the microbial count in the injection area. Care should be taken to prevent touching the needle to contaminated areas such as the outer surface of the cap, ampule, and tables. Drawing the medication from the ampule should be quick to minimize exposure. Swabbing has to be done from the center to the periphery to push germs away from the injection site.

What happens during the incubation period of infection?

Interval between entrance of pathogen into the body and appearance of first symptoms

What can help prevent HAIs?

Meticulous hygiene practices, using chlorhexidine washes for bathing and personal hygiene care, advances in ICU infection prevention, and the creation EB bundles to help overt these infections

What happens during the prodromal stage of infection?

Microbes grow and multiply. Onset of. Nonspecific S&S like malaise, low-grade fever, and fatigue —> become more specific S&S Ex: herpes simplex begins w/ itching and tingling at the site before the lesion appears

Is double bagging indicated for infected materials if the outside of the bag is not contaminated?

No, A single intact, standard-size linen bag that is not overfilled and that is tied securely is adequate to prevent infection transmission. Check the color code of bag that your agency uses for bagging these items.

What nutrients are important associated with surgery, extensive burns, and febrile conditions?

PROTEIN

What precautions do we use with Droplet Precautions (Droplets >5 μm; being within 3 feet of the patient)?

Private room or cohort patients; mask or respirator (refer to agency policy) Ex: Influenza, adenovirus, group A streptococcus, Neisseria meningitides, pertussis, rhinovirus, mycoplasma pneumoniae, pertussis, diphtheria, pneumonic plague, rubella, mumps, respiratory syncytial virus

What precautions do we use with Contact Precautions (Direct patient or environmental contact)?

Private room or cohort pts, gloves, and gown Ex: 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

What precautions do we use with airborne precautions?

Private room; negative-pressure airflow of at least 6-12 exchanges per hour via HEPA filtration; mask or respiratory protection device, N95 respirator Ex: Measles, chickenpox (varicella), disseminated herpes zoster, Mycobacterium tuberculosis, rubeola

What precautions do we use with protective environment?

Private room; positive airflow. with ≥12 air exchanges per hour; HEPA filtration for incoming air; mask, gloves, gowns Ex: allogenic hematopoietic stem cell transplants

What precaution do we use with ALL pts?

Standard precautions: • Standard Precautions apply to blood, blood products, all body fluids, secretions, excretions (except sweat), nonintact skin, and mucous membranes. • Perform hand hygiene before direct contact with patients; between patient contacts; after contact with blood, body fluids, secretions, and excretions and with equipment or articles contaminated by them; and immediately after gloves are removed. • When hands are visibly soiled or contaminated with blood or body fluids, wash them with either a nonantimicrobial soap or antimicrobial soap and water. • When hands are not visibly soiled or contaminated with blood or body fluids, use an alcohol-based hand rub to perform hand hygiene. • Wash hands with nonantimicrobial or antimicrobial soap and water if contact with spores (e.g., Clostridium difficile) is likely to have occurred. • Do not wear artificial fingernails or extenders if duties include direct contact with patients at high risk for infection and associated adverse outcomes. • Wear gloves when touching blood, body fluids, secretions, excretions, nonintact skin, mucous membranes, or contaminated items or surfaces. Remove and dispose of gloves and perform hand hygiene between patient care encounters and when going from a contaminated to a clean body site. • Wear PPE when your anticipated patient interaction is likely to involve contact with blood or body fluids. • A private room is unnecessary. Check with the infection prevention and control professional of your agency. • Discard all contaminated sharp instruments and needles in a puncture-resistant container. Health care agencies must make needleless devices available. Activate the mechanical safety device, if present. If needle recapping is necessary, use the one-handed scoop method and dispose of the capped needle as soon as possible. • Respiratory hygiene and cough etiquette: Have patients cover the nose or mouth when sneezing or coughing; use tissues to contain respiratory secretions and dispose in nearest waste container; perform hand hygiene after contact with respiratory secretions and contaminated objects or materials; contain respiratory secretions with procedure or surgical mask; sit at least 3 feet away from others if coughing.

Normal for as maintain a sensitive balance with other microorganisms to prevent infection. Any factor that disrupts this balance places a person at increased risk for acquiring a disease. For example, the use of broad-spectrum antibiotics for the treatment of infection can lead to ____.

Suprainfection: this develops when broad-spectrum antibiotics eliminate a wide range of normal flora organisms, not just those causing infection

T or F. It is important to know how a pt reacts to an infection or infectious disease when establishing a plan of care. The challenge is to identify and support behaviors that maintain human health or prevent infection.

T

T or F. In som older adults, an infection may be advanced before it is identified.

T! B/c of the aging process, there is a reduced inflammatory and immune response, so they have to get more "severe" for us to notice and it be on our radar. They may not always get a fever or a gig fever. Look for confusion, incontinence, or agitation Ex: with older adults w pneumonia, they do not always have typical S&S, they usually only get the increased HR, confusion, generalized fatigue —> have them get pneumonia vaccine (rec. for all ppl 65+)

How does thee body react with stress?

The body responds to emotional or physical stress by the general adaptation syndrome -During the alarm stage the basal metabolic rate increases as the body uses energy stores. Adrenocorticotropic hormone increases serum glucose levels and decreases unnecessary antiinflammatory responses through the release of cortisone. -***If stress continues or becomes intense, elevated cortisone levels result in decreased resistance to infection. Continued stress leads to exhaustion, which causes depletion in energy stores, and the body has no resistance to invading organisms. The same conditions that increase nutritional requirements, such as surgery, trauma, and increase of physiological stress

What is the major route of transmission for pathogens identified in the health california setting?

Unwashed hands of the healthcare worker

which method is effective in controlling the transmission of infection in health care? a. vaccinations b. isolation precautions c. hand-hygiene practices d. use of clean equipment

c. hand-hygiene practices

reservoir: Escherichia coli

causes infections such as gastroenteritis and urinary tract infections in pts (colon)

which type of isolation precaution is appropriate for a pt with influenza?

droplet precautions

What are the stages of infection?

incubation, prodromal, illness (SIRS and inflammation), decline, convalescence

when would you use a positive airflow?

pts with allogeneic hematopoietic stem cell transplants as a preventative environment precaution

What happens during convalescence stage of infection?

symptoms are largely gone but the body is still recovering. Interval where acute symptoms of infection disappear (length of recovery depends on severity of infection and pt's host resistance-could take days to months)

which nursing intervention would be appropriate to reduce the risk of transmission of tuberculosis?

wearing an N95 respirator and wearing gloves while performing a physical exam-you would also want a negative airflow room (airborne infection isolation room). you would want a surgical mask when the pt is 3 feet away or less to reduce risk of transmission of large droplet nuclei. you wouldn't "not need" a mask when you are outside of the pt's room

Implications for pt-centered care:

• Assess a patient's literacy and identify the best method for communication and patient teaching for the patient and family. This may include a community elder, an interpreter, or a family member. • Determine initially whether the patient has any signs of fear, anxiety, or confusion about the condition and treatment plan. • Reinforce that infection control and isolation procedures are designed for patient safety. Use simple language to explain. • Explain each item used for infection control and isolation procedures, and obtain feedback from the patient to determine the level of understanding. • Be aware that in some cultures touch from a person who is not a family member is not appropriate. Prepare the patient by explaining why you need to touch; when possible, ask permission. For example, say, "I need to check your arm that has an IV line. May I do that now?" • If the patient seems fearful of the isolation equipment, continually reinforce why you are wearing the equipment. • Using culturally sensitive care, identify unique approaches to help patients who are on isolation precautions understand why the precautions are necessary. Answer any questions, and allay the fear of patients and families.

Regardless of the type of isolation or barrier protection you use, follow these basic principles when caring for patients:

• Understand how certain diseases are transmitted and which protective barriers to use. • Use thorough hand hygiene before entering and leaving the room of a patient in isolation. • Dispose of contaminated supplies and equipment in a manner that prevents spread of microorganisms to other people as indicated by the mode of transmission of the organism. • Protect all people who might be exposed during transport of a patient outside the isolation room.