1.

1 Lesson Objectives Upon completion of this lesson, you will be able to: Explain the relationship of the chain of infection to the transmission of infection. Describe the signs and/or symptoms of a localized infection and those of a systemic infection. Identify patients most at risk for an infection. Explain conditions that promote the transmission of health care-associated infection. 1.2 Introduction Health-care-associated infections (HAIs) are those that develop as a result of a stay and/or visit in a health care facility. A hospital is one of the most likely places for acquiring an infection because it harbors a high population of virulent (infectious) strains of microorganisms that may be resistant to antibiotics. Iatrogenic infections are health care-associated infections resulting from a diagnostic or therapeutic procedure. For example, following a gastrointestinal endoscopy a patient develops a P. aeruginosa infection. Health-care-associated infections are exogenous or endogenous. An exogenous infection comes from microorganisms outside the patient. For example, a postoperative wound infection is exogenous. Endogenous organisms are caused by normal flora or virulent organisms that live on the skin. An endogenous infection can occur when part of the patient's flora becomes altered and an overgrowth results. For example, a patient is placed on several antibiotics in the hospital setting and develops C. difficile (commonly found in the G.I. tract) infection as a result. The signs and/or symptoms of infection may be local and/or systemic. If an infection is localized (e.g., a wound infection), the patient has symptoms, such as pain and tenderness and redness at the wound site. Because there may be drainage from open lesions and/or wounds, you should wear clean gloves. Infected drainage may be yellow, green, or brown, depending on the pathogen. The patient may complain of localized tightness and pain caused by edema. If the infected area is large enough, movement of a body part may be restricted. Gentle palpation of an infected area usually results in some degree of tenderness. Systemic infections cause more generalized symptoms than local infection. They usually result in fever, fatigue, or malaise. Lymph nodes that drain the area of infection often become enlarged, swollen, or tender during palpation. Systemic infections commonly cause a loss of appetite, nausea, vomiting, and an elevation in white blood cell (WBC) count.

1.4 Risk Factors Risk factors for health care-associated infection include: Exposure to microorganisms within a health care facility A patient's length of stay Persons with chronic illness Compromised immunity In acute care and/or ambulatory care facilities, patients can be exposed to new and/or different microorganisms. Some of the microorganisms may be resistant to most antibiotics. In all settings, patients may have procedures and/or treatments that lower their resistance to infections. For example, patients' immune systems may be altered after receiving radiation or chemotherapy, making them more susceptible to infections, even from their own normal flora. In all health care settings, you are responsible for teaching patients and their families about the source and transmission of infections, the reason for susceptibility, and infection-control principles.
1.6 Chain of Infection

The presence of a pathogen does not mean that an infection will begin. Development of an infection occurs in a cycle, described as the chain of infection, and depends on the presence of six elements: 1. An infectious agent or pathogen 2. A reservoir or source for pathogen growth 3. A portal or exit from the reservoir (e.g., skin and mucous membranes, respiratory tract, urinary tract, gastrointestinal tract, reproductive tract, and blood) 4. A mode of transmission (e.g., hands of health care workers, stethoscope, thermometer, droplet nuclei) 5. A portal of entry to the host (e.g., skin and mucous membranes, respiratory tract, urinary tract, gastrointestinal tract, reproductive tract, and blood)

6. A susceptible host An infection develops when the chain remains intact. However, when you use infection-control practices, you can break an element of the chain and prevent the infection from being transmitted to the patient. Laboratory Tests to Screen for Infection 1.9 Asepsis Asepsis is defined as the absence of disease-producing (pathogenic) organisms. Aseptic technique involves the purposeful prevention of the transfer of microorganisms. The two types of aseptic technique you practice are medical and surgical asepsis.

1.10 Medical Asepsis Medical asepsis (or clean technique), includes procedures used to reduce the number of and prevent the spread of microorganisms. Hand hygiene, cleaning the environment, and use of clean gloves and masks (barrier techniques) are examples of medical asepsis. 1.11 Surgical Asepsis Surgical asepsis, or sterile technique, includes procedures used to eliminate all microorganisms from an area. For example, sterilization destroys all microorganisms and their spores. Use of sterile instruments and gloves in the operating room and special procedural areas are additional examples of surgical aseptic technique. 1.13 Standard Precautions In 1996 the Centers for Disease Control and Prevention (CDC) published guidelines for the set of precautions known as standard precautions. Part of the rationale for the development of standard precautions is the fact that any patient may be a source for infection, requiring health care workers to use personal protective equipment (PPE) to prevent exposure. Standard precautions protect nurses from potential contact with blood and body fluids. Besides gloving, standard precautions include the use of masks, eye protection, and gowns when there is a risk of being splattered with infectious materials. Make standard precautions a routine part of your practice and use the precautions in every patient encounter.