Infection Control Nursing 101

Prof. Tina Iakovou RN, MA, MSN Fundamentals of Nursing Fall 2011

Infection Control

Infection control practices are directed at controlling or eliminating sources of infection in the health care agency, home, or community.

Pathogens, Infection, and Colonization

Pathogenicity Pathogens Virulence Opportunistic Pathogens

Infection
infectious agents

Communicable Disease

The result of a communicable agent being transmitted to a client by direct or indirect contact, through a vehicle (or vector) or airborne route

Colonization
Colonization is the multiplication of microorganisms on or within a host that does not result in cellular injury. Flora are the vegetation of microorganisms on the human body.

Resident flora
Transient flora

Chain of Infection

Microorganism (infectious agent) Source or reservoir Portal of exit from reservoir Mode of transmission Portal of entry into host Susceptible host

CHAIN OF INFECTION

Bacteria, Virus, Fungi, Parasites (includes protoza)

Resistance of the individual

Humans, animals,food, water, milk, soil, inanimate objects (equipment).

Same as portal of exit

Humans: GI, GU, skin breaks, blood, mucous membranes, genital tract.

Contact, Vehicle (liquids, food, fomites), Vector, Airborne (droplets or dust).

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Microorganisms that cause Infections

Bacteria Viruses Fungi

Parasites

Infectious Agents
The ability of a microorganism to infect a client is related to:
Virulence of the agent Number of microorganisms present Ability of the agent to enter and live in the client Susceptibility of the client Resident Infectious Agents:

Transient Infectious Agents:

Source or Reservoir
Required for the microorganism to survive while awaiting a host. May allow the organism to multiply, making it more dangerous.

The human body is the most common reservoir. Food, plants, animals, and feces are other common reservoirs.

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Portals of Exit
Pathway by which pathogens leave the body of a host Respiratory Tract

GI tract/Urinary Tract

Blood

Method of Transmission

Pathway by which pathogens leave the body of a host.

Direct Transmission

Sources of Direct Transmission:

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Method of Transmission

Indirect Transmission Vehicles (fomites) Vectors

Airborne Transmission

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Portal of Entry

Pathway by which infectious agents gain access to the body

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Susceptible Host
A person with a reduced immune response has increased susceptibility. The immune response is the bodys natural defense against infection.

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Factors Influencing Production of an Infectious Disease

Age

Heredity

Stress

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Factors Influencing Production of an Infectious Disease

Surgery

Nutrition

Health Status

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Normal Defense Mechanisms

Nonspecific and specific immune defenses work in

harmony to defend the host from pathogens. Nonspecific Immune Defenses Protect the host from all microorganisms Not dependent on prior exposure to the antigen

Nonspecific Immune Defenses

Skin and Normal Flora Mucous Membranes Sneeze, Cough Reflexes

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Nonspecific Immune Defenses

Tearing Reflexes Elimination Acidic Environment

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INFLAMMATORY RESPONSE

Inflammation is a local and nonspecific defensive response of the tissues to an injurious or infectious agent. It is characterized by 5 signs: 1. Pain 2. Swelling 3. Redness 4. Heat 5. Impaired function of the part

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Stages of the InflammatoryResponse

Stage 1: Vascular and Cellular response Injured tissues release histamine which increase blood flow to area causing redness and heat. Cell death occurs and there is an outpouring of fluid, proteins and leukocytes (WBC) causing swelling. Bone Marrow produces BCs (Leukocytosis) W The pressure caused by the accumulated fluid on the local nerve endings cause pain and immobility.

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Stages of the Inflammatory Response

Stage 2: Exudate Production

In this 2nd stage an exudate is produced consisting of fluid, dead phagocytic cells,and dead tissue cells. The major types of exudate are: SerousSanguinousSero-sanguinousPurulent-

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Stages of the Inflammatory Response

Stage 3: Reparative Phase

In this last stage of the inflammatory response, repair of the injured tissues occurs by regeneration or replacement with fibrous tissue (scar)
Tissues that have poor regeneration capability are: nervous, muscular, and elastic tissues

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Specific Immune Defense (The Immune Responses)

Immunity is a specific defense mechanism that creates an immune response to a specific invading antigen. The immune response has 2 components:

Antibody mediated defenses Cell mediated defenses

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The Humoral Immune Response

B lymphocytes recognize the antigen as an enemy. Immunoglobulins are plasma protein cells that produce five different classes of antibodies (IgM, IgG, IgA, IgD, and IgE). Immunoglobulins circulate throughout the bloodstream for the purpose of destroying antigens.

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Cell-Mediated Immunity
Fights pathogens that survive inside cells. Antigen stimulates the release of activated T cells.

T-helper cells T-suppressor cells T-cytotoxic cells

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Active Immunity
Host produces antibodies in response to natural antigens

or artificial antigens Natural active immunity

body Duration lifelong

Antibodies are formed in presence of active infection in the

Artificial active immunity Antigens administered to stimulate antibody formation Lasts for many years Reinforced by booster

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Passive Immunity
Host receives natural or artificial antibodies produced

from another source Natural passive immunity

Antibodies transferred naturally from an immune mother to

baby through the placenta or in colostrums Lasts 6 months to 1 year

Artificial passive immunity Occurs when immune serum (antibody) from an animal or another human is injected Lasts 2 to 3 weeks
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Types of Infections

Infection results from tissue invasion and damage by an infectious agent. Local InfectionSigns of localized Infection:

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Systemic infectionSigns of Systemic Infection: Disease- occurs when there is a change in normal tissue function and signs and symptoms occur.

Types of Infections
Acute infection Chronic infection

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Types of Infections

Bacteremia-

SepticemiaNosocomial InfectionsIatrogenic Infections

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Signs of Infection
Laboratory data:

Elevated WBC count Elevated WBC Differentials Elevated ESR Positive Cultures of urine, blood, sputum or other drainage

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Stages of Infection

Incubation-time interval between invasion of the body by pathogens and onset of symptoms. During this time period, the pathogens invade the tissue and begin to multiply to produce infection. Prodromal-time interval from the onset of vague, non-specific symptoms until specific symptoms of infection appear. Most infectious at this time. Full stage/illness-specific symptoms of infection are evident. Convalescent stage-Time period when symptoms subside and client returns to previous state of health.

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Nosocomial Infections
Infections acquired in a health care setting that were not present or incubating at the time of the clients admission Common sites of Nosocomial Infections: Urinary tract Surgical wounds Respiratory tract Bloodstream

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Nosocomial Infections

Procedures identified as possible sources of infection are:

Inadequate handwashing Catheterization technique Improper suctioning technique Improper dressing-change technique Contamination of closed drain system

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Infection Chain

Breaking the chain of infection; preventive measures follow each critical link in the chain of infection.

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Asepsis
Asepsis is the absence of microorganisms. Aseptic technique is the infection control practice used to prevent the transmission of pathogens.

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Medical Asepsis (Clean Technique)

Practices to reduce the number, growth, and spread of microorganisms

The most common cause of nosocomial infections is contaminated hands of health care providers. Wash hands before and after every client contact.

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Surgical Asepsis (Sterile Technique)

Practices that eliminate all microorganisms and spores from an object or area

Surgical scrub Surgical attire Sterile fields Sterile instruments and equipment

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Breaking the Chain of Infection

Etiologic agent

Correctly cleaning, disinfecting or sterilizing articles before use Educating clients and support persons about appropriate methods to clean, disinfect, and sterilize article

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Breaking the Chain of Infection

Reservoir (source) Changing dressings and bandages when soiled or wet 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

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Breaking the Chain of Infection

Portal of exit
Avoiding talking, coughing, or sneezing over open wounds or

sterile fields Covering the mouth and nose when coughing or sneezing

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Breaking the Chain of Infection

Method of transmission
Proper hand hygiene Instructing clients and support persons to perform hand

hygiene before handling food, eating, after eliminating and after touching infectious material Wearing gloves when handling secretions and excretions Wearing gowns if there is danger of soiling clothing with body substances

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Breaking the Chain of Infection

Method of transmission Placing discarded soiled materials in moisture-proof refuse bags Holding used bedpans steadily to prevent spillage Disposing of urine and feces in appropriate receptacles Initiating and implementing aseptic precautions for all clients Wearing masks and eye protection when in close contact with

clients who have infections transmitted by droplets from the respiratory tract Wearing masks and eye protection when sprays of body fluid are possible

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Breaking the Chain of Infection

Portal of entry
Using sterile technique for invasive procedures, when exposing

open wounds or handling dressings Placing used disposable needles and syringes in punctureresistant containers for disposal Providing all clients with own personal care items

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Breaking the Chain of Infection

Susceptible host
Maintaining the integrity of the clients skin and mucous

membranes Ensuring that the client receives a balanced diet Educating the public about the importance of immunizations

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Category-specific Isolation Precautions

Strict isolation Contact isolation Respiratory isolation Tuberculosis isolation Enteric precautions Drainage/secretions precautions

Blood/body fluid precautions

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Disease-specific Isolation Precautions

Delineate practices for control of specific diseases
Use of private rooms with special ventilation Cohorting clients infected with the same organism Gowning to prevent gross soilage of clothes

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Universal Precautions (UP)

Used with all clients Decrease the risk of transmitting unidentified pathogens Obstruct the spread of bloodborne pathogens (hepatitis B

and C viruses and HIV) Used in conjunction with disease-specific or category-specific precautions

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 Employs generic infection control precautions for all clients

Body Substance Isolation (BSI)

Blood Urine Feces Wound drainage Oral secretions Any other body product or tissue

Body substances include:

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Standard Precautions (CDC/1996)

Used in the care of all hospitalized persons regardless of their

diagnosis or possible infection status Barrier Precautions

and body fluids

Use of masks, gowns, and gloves to minimize the risk of exposure to blood

Apply to Blood All body fluids, secretions, and excretions except sweat (whether or not blood is present or visible) Nonintact skin and mucous membranes
Combine the major features of UP and BSI

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Transmission-based Precautions
Used in addition to standard precautions
For known or suspected infections that are spread in one of three

ways: Airborne Droplet Contact May be used alone or in combination but always in addition to standard precautions

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Role of Health Care Personnel and Health Agencies in Infection Control

Mask and eye protection or face shield Non-sterile gown Tuberculosis masks Isolation precautions initiated when positive cultures from a draining wound are reported

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Role of Health Care Personnel and Health Agencies in Infection Control

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This nurse is interacting with a client who requires isolation precautions.

Role of Health Care Personnel and Health Agencies in Infection Control

Labeling of all articles leaving the room Use of impermeable bags or double bagging Client and family instruction Alert to psychological discomfort

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Role of Health Care Personnel and Health Agencies in Infection Control

Blood Borne Pathogen Exposure

OSHA requires that all health agencies make available the hepatitis B vaccine and vaccination series to all employees.

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Regulatory Agencies:
Help to control the spread of microorganisms and protect people from communicable diseases. The World Health Organization is the major regulatory agency at the international level. The Center for Disease Control and prevention (CDC) is the public health agency on the national level . On the state level, Health Departments, tract reportable diseases. Ex. West-Nile, SARS.
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Principles of Antimicrobial Therapy

Antimicrobials are drugs used in the management of infections Bacteriocidal drugs kill bacteria whereas Bacteriostatic drugs inhibit bacterial growth but rely on the immune system to eradicate the pathogen. Types of antimicrobial drugs include: Antibacterial drugs Antiviral drugs Antifungal drugs Antibacterial drugs are classified as: Broad-spectrum - effective against many types of bacteria Narrow-spectrum- effect only a few microorganisms.
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Principles of Antimicrobial Therapy

Antimicrobial therapy is effective because of the principle of selective toxicity: the ability of the drug to harm the pathogen without injuring the host. Drug resistance is a major problem in antimicrobial therapy. The most important principle in the management of infection is to: use the right drug for the right bug A culture determines the pathogen whereas a sensitivity test determines the susceptibility of the pathogen to a particular antibiotic The most important element of patient education is to advise the patient to complete the entire course of therapy with the prescribed dose and intervals
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Principles of Antimicrobial Therapy

Hypersensitivity/Allergic Response Antigen-antibody reaction s/s: Superinfection- secondary infection that develops when antibiotics change the inhibitory influence of normal flora. More likely to occur with use of broad-spectrum antibiotics

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