Infection Control Terminology

Terminologies

• Infection occurs when microorganisms invade and proliferate in body tissue.
• Asepsis is the absence of disease-producing microorganisms and being free from infection.
• Medical asepsis involves practices to reduce the number and transfer of pathogens and is considered a clean technique.
• Surgical asepsis involves practices to keep objects and areas free from microorganisms, and is considered a sterile technique.
• Sepsis is the presence of infection.
• Septicemia is the transport of an infection or its products throughout the body or blood.
• A carrier is a person or animal without illness signs but harbors a pathogen that can be transferred.
• A contact is a person or animal known or believed to have been exposed to a disease.
• A reservoir is the natural habitat for the growth and multiplication of microorganisms.
• Transient flora or bacteria are microorganisms picked up by the skin due to normal activities and can be easily removed.
• Resident flora or bacteria are microorganisms that normally live on a person's skin.
• Sterilization is the process of destroying all microorganisms, including their spores.
• A disinfectant is used on inanimate objects to destroy pathogens but not necessarily spores.
• An antiseptic is used on people to inhibit pathogen growth but not necessarily destroy them.
• Bactericidal substances kill microorganisms.
• Bacteriostatic agents prevent bacterial multiplication but do not kill them.
• Contamination is the process by which something becomes unclean.
• Disinfection involves the use of disinfectants.
• Communicable diseases result from an infectious agent transmitted through direct or indirect contact, a vector, a vehicle, or airborne means.
• Infectious diseases result from the invasion and multiplication of microorganisms in a host.
• A pathogen is a disease-producing microorganism.
• Pathogenicity is the ability to produce disease.
• Virulence is the vigor with which a microorganism can grow and multiply.
• An opportunistic pathogen causes disease only in a susceptible individual.

Stages of Infection

• Incubation period extends from microorganism entry to onset of signs/symptoms (S/Sx).
• Prodromal period extends from nonspecific S/Sx to appearance of specific S/Sx.
• Illness period involves the development of specific S/Sx.
• Convalescent period involves the abatement of S/Sx until the client returns to a normal state of health.

Chain of Infection

• Etiologic/Infectious agents can be bacteria, viruses, fungi, or parasites.
  • An infectious agent's ability to cause disease depends on its pathogenicity, virulence, invasiveness, and specificity.
• A reservoir serves as a source for microorganisms (e.g., human, animal, or plant).
• Portal of exit examples include urine, feces, saliva, drainage tube, semen, vaginal discharge, sputum, emesis, stool, and blood.
• Mode of transmission includes contact, droplet, vehicle, airborne, or vector.

Method of Transmission

• Direct transmission involves immediate transfer through touching, biting, kissing, or intercourse.
• Indirect transmission involves:
  • Vehicle-borne: transfer via vehicles or contaminated items (e.g., food, water, milk, blood).
  • Vector-borne: a vector (animal or insect) transports the infectious agent (e.g., mosquitoes).
  • Airborne: particles travel more than 3 feet and remain suspended (e.g., dust particles carrying pathogens).
• Portal of entry permits organism to enter the host.
• Susceptible hosts are at risk of infection (e.g. malnourished children)

Host Susceptibility Factors

• Intact skin and mucous membranes provide a first line of defense.
• Normal pH levels in secretions and the genitourinary tract help prevent microbial invasion.
• Age, sex, and race can influence susceptibility.
• Immunization helps resist infection.
• Fatigue, climate, general health status, pre-existing illness, and some medications may affect susceptibility.

Body Defenses Against Infection - Types of Immunization

• Active Immunization: Antibodies produced by the body in response to infection.
  • Natural: Antibodies formed in the presence of active infection, providing lifelong immunity (e.g., recovery from mumps or chickenpox).
  • Artificial: Administered antigens (vaccines or toxoids) to stimulate antibody production and requires boosters (e.g., tetanus toxoid and oral polio vaccine).
• Passive Immunization: Antibodies produced by another source (animals or humans).
  • Natural: Antibodies transferred from mother to newborn through the placenta or colostrum.
  • Artificial: Injected immune serum (antibody) from an animal or another human (e.g., Tetanus Immunoglobulin Human or TIGH).
• Aseptic practices break the chain of infection.
  • These practices include handwashing, cleaning, sterilization, disinfection, using barriers, isolation systems, and surgical asepsis.

Safety, Security, and Emergency Preparedness

• The environment contains hazards, both seen and unseen.
• A safe environment is free from thermal, mechanical, radiation, electrical, microbial, chemical, and psychological injuries.
• Characteristics of a safe environment include adequate lighting, neatness, cleanliness, safe equipment, comfortable noise level, medication safety, suitable temperature, and freedom from pollution.

Factors Affecting People's Ability to Protect Themselves

• Infants, toddlers, and preschoolers: injuries are a leading cause of death.
• School age: risk of injury from others or sports.
• Adolescents: drug use and accidents.
• Adults: lifestyle habits (smoking, alcohol, stress) and accidents.
• Older adults: falls, burns, and accidents.
• Other factors: orientation, level of consciousness, emotions, injury/illness, sensory/communication impairment, and safety awareness.

Risks in Health Care Agencies

• Falls
• Client-inherent accidents
• Procedure-related accidents
• Equipment-related accidents

Safety Precautions in Health

• Infants:
  • Provide soft, large toys, keep crib sides up, hold during feeding, and keep sharp objects/electric outlets away
  • Never leave infants alone.
• Toddlers:
  • Keep sharp objects/matches, pots on stove back burners, cleaning solutions/insecticides, and medicines secured.
  • Teach toddlers the "do's and don'ts."
• Preschoolers:
  • Teach them to observe and act safely.
• School-age children:
  • Educate on equipment use and traffic rules.
• Adolescents/Adults:
  • Develop inner discipline and understand dangers of drug use.
• Elderly:
  • Keep hallways clean, use dim lights at night, install bathroom handrails, and keep frequently used items within reach.

Safety Precautions in Illness

• Falls and other mechanical trauma can occur.
• Protective devices like side rails and restraints may be needed.
• Guidelines for restraints:
  • Provide much freedom as possible
  • Ensure circulation is not occluded
  • Pad bony prominences
  • Attach restraint to the bed frame
  • Remove every two hours as per doctor's instructions
  • Requires a doctor's order per episode and consent from relatives.
• Other traumas include burns, chemical trauma and radiation trauma.

Medications

• Medications are substances administered for diagnosis, cure, treatment, symptom relief, or disease prevention.
• Drugs are substances that alter physiological function with the potential to affect health.
• Pharmacology involves studying the effects of drugs on living organisms.
• A prescription provides written direction for drug preparation and administration.

Drug Nomenclature

• Chemical Name: precisely describes the drug's constituents (e.g., Ibuprofen (anti-inflammatory)).
• Generic Name: name by which the drug is known worldwide; agreed upon by the WHO (e.g., Acetaminophen).
• Trade Name: brand name given by the drug manufacturer which identifies its property (e.g., Calpol).
• Official Name: name under which a drug is listed in official publications.

Purposes of Medication

• Diagnostic: identify any disease.
• Prophylaxis: prevent disease occurrence.
• Therapeutic: cure the disease.

Uses of Drugs

• Prevention (e.g., vaccines)
• Diagnosis (e.g., TB testing)
• Suppression (e.g., anti-cancer or antiviral drugs)
• Treatment (e.g., anti-asthmatic drugs)
• Cure (e.g., antibiotics)
• Health supplements (e.g., vitamins, minerals)

Legal Aspects of Medications

• Dangerous Drug Act – 1030 and The Narcotic Drugs and Psychotropic Substances Act -1985 governs the procurement and use of certain drugs.
• The Comprehensive Dangerous Drugs Act of 2002 applies at the national level in the Philippines
• Republic Act No. 6425, otherwise known as the Dangerous Drugs Act of 1972, as amended, provides funds for drug control.
• Dangerous drugs must be secured in a locked cupboard under the care of trusted senior nurses and nurses are responsible for their actions.

Types of Drug Preparations

• Aerosol spray or foam: deposited in a thin layer on the skin by air pressure.
• Aqueous solution: one or more drugs dissolved in water.
• Aqueous suspension: drugs finely divided in a liquid form such as water.
• Caplet: solid, capsule-shaped, coated for easy swallowing.
• Capsule: gelatinous container holding drug in powder, liquid, or oil form.
• Cream: non-greasy, semisolid for skin application.
• Elixir: sweetened, aromatic alcohol solution for medicinal agents.
• Extract: concentrated form of drug made from vegetables or animals.
• Gel or jelly: clear, translucent semisolid that liquefies when applied to the skin.
• Liniment: medication mixed with alcohol, oil, or soapy emollient for skin application.
• Lotion: medication in a liquid suspension applied to the skin.
• Lozenge (troche): flat, round, or oval preparation that dissolves in the mouth.
• Ointment (salve, unction): semisolid preparation of one or more drugs for skin/mucous membrane application.
• Paste: preparation like an ointment but thicker/stiffer, penetrating the skin less.
• Pill: one or more drugs mixed with a cohesive material in oval, round or flattened shapes.
• Powder: Finley ground drug(s), either for internal or external usage.
• Suppository: one or several drugs mixed with a firm base (e.g., gelatin) for insertion into the body and dissolves gradually at body temperature, releasing the drug.
• Syrup: aqueous solution of sugar used to disguise unpleasant drug tastes.
• Tablet: powdered drug compressed into a hard disk and some are enteric coated.
• Tincture: alcoholic/water-alcohol solution from drugs derived from plants.
• Transdermal patch: semipermeable membrane disk/patch with drug absorbed through skin over time.
• Parenteral:
  • Subcutaneous (hypodermic): into subcutaneous tissue just below skin.
  • Intramuscular (IM): into a muscle.
  • Intradermal (ID): under the epidermis (into the dermis).
  • Intravenous (IV): into a vein.

Routes of Drug Administration

• Routes of drug administration include oral, parenteral, topical, or inhalational.
• Oral (p.o. or per orem): by mouth (e.g., tablets, capsules, lozenges, and liquids), with slower absorption through the GI tract.
• Buccal (BUCC): placed between the cheek and gum.
• Sublingual (SL): placed under the tongue, bypasses the GI tract for faster absorption (e.g., nitroglycerine for chest pain).
• Parenteral: administration into muscle or vein and bypasses the GI tract for fast absorbtion.
  • Safety risks include rapid administration and exposure to bloodborne pathogens.
  • Methods of injection: Intradermal (ID), Subcutaneous (Subq), Intramuscular (IM), and Intravenous (IV) which includes IVPB Intravenous piggyback, IV push (IVP).
• Parenteral drug packaging:
  • Ampule: a glass or plastic container that is sealed and sterile.
  • Cartridge: small barrel prefilled with sterile drug.
  • Vial: small bottle with a rubber diaphragm that can be punctured by a needle.

Drug Administration - Other Routes

• Epidural: into the epidural space
• Intraosseous: into the bone marrow
• Intraperitoneal: into the peritoneal cavity
• Nasogastric Tube (NGT), Intubation
• Percutaneous Endoscopic Gastrostomy (PEG) tube
• Intraarterial: into the arteries.
• Transdermal (TD): transdermal patch like nitro for chest pain.
• Endotracheal tube (ETT): breathing tube where Lidocaine, atropine, naloxone, Epinephrine, or diazepam can be administered.
• Inhalation: through the mouth or nose.
• Topical: application on the skin or like a medication patch for the slow release of medication.
• Urethral: liquid drugs instilled into the bladder.
• Vaginal and rectal
• Eye or ears, nose: cream, ointments, drops or irrigation.

Nursing Interventions to Promote Healthy Physiologic Responses

• Hygiene
• Skin Integrity
• Mobility and Activity
• Rest and Sleep
• Comfort and Pain Management
• Nutrition
• Urinary Elimination
• Bowel Elimination
• Oxygenation and Perfusion
• Fluid, Electrolyte and Acid Base Balance

Hygiene and Skin Integrity

• Hygiene is the science of health and its maintenance and is personal.
• Hygiene involves care of the skin, feet, nails, oral/nasal cavities, teeth, hair, eyes, ears, and perineal-genital areas.
• Personal hygiene: self-care activities like bathing, toileting, general hygiene, and grooming.
• Skin integrity involves the body's largest organ which serves five major functions:
  • Protection: prevents microorganism passage, serves as the first line of defense along with mucous membranes
  • Temperature regulation: cooling via perspiration evaporation and radiation which occurs when blood vessels of the skin are vasodilated. Body heat is conserved through the lack of perspiration and through vasoconstriction of the blood vessels
  • Sebum secretion: softens and lubricates hair/skin, prevents brittle hair, decreases water loss, and has bactericidal action.
  • Sensation transmission: through nerve receptors for pain, temperature, touch, and pressure.
  • Vitamin D production: occurs in conjunction with ultraviolet rays from the sun

Wounds - Types

• Clean wounds: uninfected with minimal inflammation; the respiratory, gastrointestinal, genital, and urinary tracts are not entered and are primarily closed.
• Clean-contaminated wounds: surgical wounds where above tracts are entered but show no infection signs.
• Contaminated: open, fresh, accidental wounds and surgical wounds involving a major sterile technique break or spillage from the gastrointestinal tract.
• Dirty/Infected: containing dead tissue and evidence of clinical infection (e.g., purulent drainage).

Wounds - By Depth

• Partial thickness: confined to the dermis and epidermis and heal by regeneration.
• Full thickness: involving the dermis, epidermis, subcutaneous tissue, and sometimes muscle/bone and requiring connective tissue repair.
• Pressure ulcers: injury to skin/underlying tissue, usually over a bony prominence and previously called decubitus ulcers, pressure sores, or bedsores.
  • Pressure ulcers are due to localized ischemia from blood supply deficiency to the tissue.