Podcast
Questions and Answers
What is the primary reason for using personal protective equipment (PPE) when providing direct care to a patient?
What is the primary reason for using personal protective equipment (PPE) when providing direct care to a patient?
- To make the patient feel more comfortable and cared for.
- To comply with hospital administrative policies.
- To minimize the cost of infection control.
- To prevent the spread of infection to the healthcare worker and other patients. (correct)
A patient with a known Clostridioides difficile infection requires assistance with hygiene. Which precaution is most important for the healthcare provider to implement?
A patient with a known Clostridioides difficile infection requires assistance with hygiene. Which precaution is most important for the healthcare provider to implement?
- Wearing a N95 respirator.
- Donning shoe covers before entering the room.
- Using an alcohol-based hand rub after contact.
- Washing hands with soap and water after contact. (correct)
Following a needlestick injury, what is the priority action?
Following a needlestick injury, what is the priority action?
- Wash the area thoroughly with soap and water. (correct)
- Begin prophylactic antibiotic treatment.
- Immediately report the incident to occupational health.
- Complete an incident report and continue with scheduled tasks.
A patient diagnosed with tuberculosis (TB) is being admitted to the medical unit. What type of transmission-based precautions should be initiated?
A patient diagnosed with tuberculosis (TB) is being admitted to the medical unit. What type of transmission-based precautions should be initiated?
Which action is most appropriate to reduce the risk of catheter-associated urinary tract infection (CAUTI) in a patient with an indwelling urinary catheter?
Which action is most appropriate to reduce the risk of catheter-associated urinary tract infection (CAUTI) in a patient with an indwelling urinary catheter?
A nurse is caring for a patient with methicillin-resistant Staphylococcus aureus (MRSA) pneumonia. In addition to standard precautions, what other measures should the nurse implement?
A nurse is caring for a patient with methicillin-resistant Staphylococcus aureus (MRSA) pneumonia. In addition to standard precautions, what other measures should the nurse implement?
A patient is prescribed antibiotics for a bacterial infection. What instruction should the nurse emphasize to promote responsible antibiotic use?
A patient is prescribed antibiotics for a bacterial infection. What instruction should the nurse emphasize to promote responsible antibiotic use?
Which factor increases an older adult's susceptibility to infection?
Which factor increases an older adult's susceptibility to infection?
What is the most effective way to prevent healthcare-associated infections (HAIs)?
What is the most effective way to prevent healthcare-associated infections (HAIs)?
A patient reports a known penicillin allergy. Which antibiotic class should the nurse be most cautious about administering?
A patient reports a known penicillin allergy. Which antibiotic class should the nurse be most cautious about administering?
A nurse is educating a patient about preventing the spread of infection at home. Which of the following instructions is most appropriate?
A nurse is educating a patient about preventing the spread of infection at home. Which of the following instructions is most appropriate?
A patient is receiving an aminoglycoside antibiotic. The nurse should monitor for which adverse effect?
A patient is receiving an aminoglycoside antibiotic. The nurse should monitor for which adverse effect?
A patient has a surgical wound that shows signs of infection. What intervention is most important for the nurse to implement?
A patient has a surgical wound that shows signs of infection. What intervention is most important for the nurse to implement?
A community experiences a sudden increase in the number of cases of a specific infectious disease. What term best describes this situation?
A community experiences a sudden increase in the number of cases of a specific infectious disease. What term best describes this situation?
A nurse is caring for a patient with Clostridioides difficile-associated diarrhea. What is the most important nursing intervention to prevent the spread of infection?
A nurse is caring for a patient with Clostridioides difficile-associated diarrhea. What is the most important nursing intervention to prevent the spread of infection?
What is the primary function of antibodies in the body's defense against infection?
What is the primary function of antibodies in the body's defense against infection?
A patient has a wound infection. What laboratory result would the nurse expect to see?
A patient has a wound infection. What laboratory result would the nurse expect to see?
A patient is diagnosed with a fungal infection. Which class of medications would the nurse expect to administer?
A patient is diagnosed with a fungal infection. Which class of medications would the nurse expect to administer?
A patient is scheduled to receive vancomycin. What laboratory value should the nurse monitor closely to assess for potential toxicity?
A patient is scheduled to receive vancomycin. What laboratory value should the nurse monitor closely to assess for potential toxicity?
A patient with a compromised immune system is at high risk for infection. What type of environment is most important for the nurse to provide?
A patient with a compromised immune system is at high risk for infection. What type of environment is most important for the nurse to provide?
A patient reports diarrhea after starting antibiotic therapy. What intervention is most appropriate?
A patient reports diarrhea after starting antibiotic therapy. What intervention is most appropriate?
What is the primary goal of infection control practices in healthcare settings?
What is the primary goal of infection control practices in healthcare settings?
A patient is diagnosed with infectious mononucleosis. What route of transmission should the nurse educate the patient about?
A patient is diagnosed with infectious mononucleosis. What route of transmission should the nurse educate the patient about?
Which of the following is an example of a vehicle-borne transmission of infection?
Which of the following is an example of a vehicle-borne transmission of infection?
A nurse is using an alcohol-based hand rub for routine hand hygiene. Which action indicates proper technique?
A nurse is using an alcohol-based hand rub for routine hand hygiene. Which action indicates proper technique?
The nurse is caring for a patient with pneumonia. Which intervention is most effective in preventing the spread of infection to others?
The nurse is caring for a patient with pneumonia. Which intervention is most effective in preventing the spread of infection to others?
When should a nurse use sterile technique (surgical asepsis)?
When should a nurse use sterile technique (surgical asepsis)?
A patient is diagnosed with Zika virus. What is a primary mode of transmission the nurse should include in patient education?
A patient is diagnosed with Zika virus. What is a primary mode of transmission the nurse should include in patient education?
A patient has a chronic wound with purulent drainage. What type of precautions should the nurse initiate?
A patient has a chronic wound with purulent drainage. What type of precautions should the nurse initiate?
What is the purpose of monitoring antibiotic serum peak and trough levels?
What is the purpose of monitoring antibiotic serum peak and trough levels?
A nurse is caring for a patient with a known Staphylococcus aureus infection. Besides contact precautions, what additional measure can help prevent the spread of this organism?
A nurse is caring for a patient with a known Staphylococcus aureus infection. Besides contact precautions, what additional measure can help prevent the spread of this organism?
A patient is prescribed metronidazole (Flagyl). The nurse should educate the patient to avoid which substance during treatment?
A patient is prescribed metronidazole (Flagyl). The nurse should educate the patient to avoid which substance during treatment?
A patient develops oral thrush (candidiasis) after antibiotic therapy. This is an example of what type of infection?
A patient develops oral thrush (candidiasis) after antibiotic therapy. This is an example of what type of infection?
Which action is most appropriate for the nurse to take when caring for a patient in airborne isolation?
Which action is most appropriate for the nurse to take when caring for a patient in airborne isolation?
A patient is admitted with suspected Ebola virus disease. What type of precautions should be implemented?
A patient is admitted with suspected Ebola virus disease. What type of precautions should be implemented?
What is the role of normal flora in preventing infection?
What is the role of normal flora in preventing infection?
A patient is to receive a dose of penicillin. Prior to administration, what is the most important question for the nurse to ask the patient?
A patient is to receive a dose of penicillin. Prior to administration, what is the most important question for the nurse to ask the patient?
When providing care to a patient, the nurse identifies a break in the patient's skin. Which of the following describes the importance of intact skin for infection prevention?
When providing care to a patient, the nurse identifies a break in the patient's skin. Which of the following describes the importance of intact skin for infection prevention?
A nurse is caring for a patient with influenza. Which nursing intervention will help to reduce the risk of spreading the infection via droplet transmission?
A nurse is caring for a patient with influenza. Which nursing intervention will help to reduce the risk of spreading the infection via droplet transmission?
A patient is diagnosed with a protozoal infection. Which of the following routes of transmission is most likely?
A patient is diagnosed with a protozoal infection. Which of the following routes of transmission is most likely?
A patient with a helminth infection asks how they contracted the disease. Which response by the nurse is most accurate?
A patient with a helminth infection asks how they contracted the disease. Which response by the nurse is most accurate?
A patient with Clostridioides difficile (C. diff) is being discharged home. Which of the following instructions is most important to prevent the spread of infection to other household members?
A patient with Clostridioides difficile (C. diff) is being discharged home. Which of the following instructions is most important to prevent the spread of infection to other household members?
The nurse is teaching a group of older adults about infection prevention. An important point to emphasize is:
The nurse is teaching a group of older adults about infection prevention. An important point to emphasize is:
A patient is diagnosed with a localized infection. Which signs and symptoms would the nurse expect to find?
A patient is diagnosed with a localized infection. Which signs and symptoms would the nurse expect to find?
An unlicensed assistive personnel (UAP) is caring for a patient with a known infection. The nurse should intervene if the UAP:
An unlicensed assistive personnel (UAP) is caring for a patient with a known infection. The nurse should intervene if the UAP:
The nurse is preparing to administer an antibiotic to a patient with a kidney disorder. What is the priority nursing action?
The nurse is preparing to administer an antibiotic to a patient with a kidney disorder. What is the priority nursing action?
A patient is diagnosed with antibiotic-associated diarrhea (AAD). What intervention should the nurse anticipate?
A patient is diagnosed with antibiotic-associated diarrhea (AAD). What intervention should the nurse anticipate?
A nurse is reviewing the immunization records for a group of adults. Which type of immunity is achieved through vaccination?
A nurse is reviewing the immunization records for a group of adults. Which type of immunity is achieved through vaccination?
A nurse is caring for a patient with a wound infection. Which laboratory result is most indicative of an infection?
A nurse is caring for a patient with a wound infection. Which laboratory result is most indicative of an infection?
A patient is diagnosed with a viral infection. The nurse anticipates that the treatment plan will focus on:
A patient is diagnosed with a viral infection. The nurse anticipates that the treatment plan will focus on:
A patient with a respiratory infection is prescribed a medication that requires monitoring of serum peak and trough levels. What is the primary purpose of this monitoring?
A patient with a respiratory infection is prescribed a medication that requires monitoring of serum peak and trough levels. What is the primary purpose of this monitoring?
A patient reports taking an antibiotic prescribed for a previous infection to treat a current cold. What information is most important for the nurse to include in patient teaching?
A patient reports taking an antibiotic prescribed for a previous infection to treat a current cold. What information is most important for the nurse to include in patient teaching?
A nurse is caring for a patient with a urinary catheter. Which intervention is most important to prevent a catheter-associated urinary tract infection (CAUTI)?
A nurse is caring for a patient with a urinary catheter. Which intervention is most important to prevent a catheter-associated urinary tract infection (CAUTI)?
The nurse is preparing to administer medication to a patient with a known allergy to penicillin. Which medication class should the nurse be most cautious about administering?
The nurse is preparing to administer medication to a patient with a known allergy to penicillin. Which medication class should the nurse be most cautious about administering?
A patient is diagnosed with a Staphylococcus aureus (staph) infection in a surgical wound. What is the most likely source of this infection?
A patient is diagnosed with a Staphylococcus aureus (staph) infection in a surgical wound. What is the most likely source of this infection?
A community experiences a rapid increase in the number of cases of a specific infectious disease. What term best describes the event.
A community experiences a rapid increase in the number of cases of a specific infectious disease. What term best describes the event.
A public health nurse is educating the community about herd immunity. Which statement best describes herd immunity?
A public health nurse is educating the community about herd immunity. Which statement best describes herd immunity?
A nurse is caring for a patient receiving an aminoglycoside antibiotic. Which assessment finding would be most concerning and warrant immediate reporting to the health care provider?
A nurse is caring for a patient receiving an aminoglycoside antibiotic. Which assessment finding would be most concerning and warrant immediate reporting to the health care provider?
A patient is prescribed metronidazole (Flagyl) for treatment of an infection. What education should the nurse provide?
A patient is prescribed metronidazole (Flagyl) for treatment of an infection. What education should the nurse provide?
During a dressing change, the nurse notes purulent drainage from a patient’s wound. Which action indicates appropriate infection control?
During a dressing change, the nurse notes purulent drainage from a patient’s wound. Which action indicates appropriate infection control?
A patient with impaired mobility is at risk for developing pneumonia. What intervention is most effective in preventing this complication?
A patient with impaired mobility is at risk for developing pneumonia. What intervention is most effective in preventing this complication?
A patient is diagnosed with a fungal infection. Which medication would the nurse anticipate being prescribed?
A patient is diagnosed with a fungal infection. Which medication would the nurse anticipate being prescribed?
A patient is suspected of having tuberculosis (TB). What is the priority nursing action?
A patient is suspected of having tuberculosis (TB). What is the priority nursing action?
Which nursing action poses the greatest risk for transmitting infection?
Which nursing action poses the greatest risk for transmitting infection?
A nurse is teaching a patient about preventing healthcare-associated infections (HAIs). Which statement by the patient indicates a need for further teaching?
A nurse is teaching a patient about preventing healthcare-associated infections (HAIs). Which statement by the patient indicates a need for further teaching?
The nurse is caring for several patients. Which patient is at highest risk for developing an infection?
The nurse is caring for several patients. Which patient is at highest risk for developing an infection?
A nurse is preparing to administer vancomycin to a patient. The nurse should monitor the patient for which potential adverse effect?
A nurse is preparing to administer vancomycin to a patient. The nurse should monitor the patient for which potential adverse effect?
What personal protective equipment (PPE) is required when caring for a patient with influenza?
What personal protective equipment (PPE) is required when caring for a patient with influenza?
A patient is diagnosed with a Clostridioides difficile infection (CDI). What action is most important for the nurse to prevent its spread?
A patient is diagnosed with a Clostridioides difficile infection (CDI). What action is most important for the nurse to prevent its spread?
A patient is diagnosed with measles. Which type of transmission-based precautions should the nurse implement?
A patient is diagnosed with measles. Which type of transmission-based precautions should the nurse implement?
Which statement best describes the role of the inflammatory response in the body's defense against infection?
Which statement best describes the role of the inflammatory response in the body's defense against infection?
The nurse is preparing to administer a medication that can cause immunosuppression. What should the nurse include in the patient's education?
The nurse is preparing to administer a medication that can cause immunosuppression. What should the nurse include in the patient's education?
A nurse is caring for a patient with a wound infection. Which of the following actions is most important to promote wound healing?
A nurse is caring for a patient with a wound infection. Which of the following actions is most important to promote wound healing?
The nurse is educating a patient about antibiotic-resistant infections. Which statement by the patient indicates an understanding?
The nurse is educating a patient about antibiotic-resistant infections. Which statement by the patient indicates an understanding?
A patient is being discharged after treatment for tuberculosis. What actions should the nurse include in discharge instructions?
A patient is being discharged after treatment for tuberculosis. What actions should the nurse include in discharge instructions?
A nurse is assessing a patient with a suspected infection. Which assessment finding is most indicative of sepsis?
A nurse is assessing a patient with a suspected infection. Which assessment finding is most indicative of sepsis?
A patient reports to the nurse they have received a diagnosis of infectious mononucleosis (IM). How should the nurse respond when asked how the disease was contracted?
A patient reports to the nurse they have received a diagnosis of infectious mononucleosis (IM). How should the nurse respond when asked how the disease was contracted?
A patient is diagnosed with influenza. To prevent droplet transmission to healthcare personnel, which of the following personal protective equipment (PPE) is most appropriate?
A patient is diagnosed with influenza. To prevent droplet transmission to healthcare personnel, which of the following personal protective equipment (PPE) is most appropriate?
The nurse is caring for a patient with a Salmonella infection causing gastroenteritis. Which action is most critical in preventing vehicle-borne transmission?
The nurse is caring for a patient with a Salmonella infection causing gastroenteritis. Which action is most critical in preventing vehicle-borne transmission?
Which of the following is an example of a physiological body defense mechanism that inhibits pathogen colonization in the gastrointestinal tract?
Which of the following is an example of a physiological body defense mechanism that inhibits pathogen colonization in the gastrointestinal tract?
A patient is prescribed gentamicin, an aminoglycoside antibiotic. What is the most important nursing action to minimize the risk of nephrotoxicity associated with this medication?
A patient is prescribed gentamicin, an aminoglycoside antibiotic. What is the most important nursing action to minimize the risk of nephrotoxicity associated with this medication?
An older adult patient in a long-term care facility presents with new onset confusion and irritability. The nurse recognizes that in older adults, these symptoms may most likely indicate:
An older adult patient in a long-term care facility presents with new onset confusion and irritability. The nurse recognizes that in older adults, these symptoms may most likely indicate:
A patient with active tuberculosis is being discharged home. Which of the following instructions is most important to include in the discharge teaching to prevent the spread of infection to household contacts?
A patient with active tuberculosis is being discharged home. Which of the following instructions is most important to include in the discharge teaching to prevent the spread of infection to household contacts?
A patient has a localized wound infection. Which assessment finding would best differentiate a localized infection from systemic sepsis?
A patient has a localized wound infection. Which assessment finding would best differentiate a localized infection from systemic sepsis?
A patient reports developing diarrhea after starting antibiotic therapy. To differentiate between antibiotic-associated diarrhea (AAD) and Clostridioides difficile infection (CDI), which assessment is most important?
A patient reports developing diarrhea after starting antibiotic therapy. To differentiate between antibiotic-associated diarrhea (AAD) and Clostridioides difficile infection (CDI), which assessment is most important?
The nurse is preparing to administer vancomycin intravenously. Which nursing intervention is most important to prevent 'red man syndrome', a potential adverse reaction?
The nurse is preparing to administer vancomycin intravenously. Which nursing intervention is most important to prevent 'red man syndrome', a potential adverse reaction?
A patient with a wound infection is prescribed a culture and sensitivity test. When should the nurse obtain the culture specimen to ensure accurate results?
A patient with a wound infection is prescribed a culture and sensitivity test. When should the nurse obtain the culture specimen to ensure accurate results?
What is the primary mechanism by which herd immunity protects unvaccinated individuals within a community?
What is the primary mechanism by which herd immunity protects unvaccinated individuals within a community?
A nurse is caring for a patient with suspected Ebola virus disease. Which type of transmission-based precautions is most critical to implement?
A nurse is caring for a patient with suspected Ebola virus disease. Which type of transmission-based precautions is most critical to implement?
A patient is diagnosed with infectious mononucleosis. What is the most appropriate advice the nurse should provide regarding transmission of the virus?
A patient is diagnosed with infectious mononucleosis. What is the most appropriate advice the nurse should provide regarding transmission of the virus?
Which nursing action demonstrates adherence to surgical asepsis during a sterile dressing change?
Which nursing action demonstrates adherence to surgical asepsis during a sterile dressing change?
A patient is receiving intravenous antibiotic therapy and reports new onset of oral thrush (candidiasis). This is most likely an example of what type of infection?
A patient is receiving intravenous antibiotic therapy and reports new onset of oral thrush (candidiasis). This is most likely an example of what type of infection?
When educating a patient about responsible antibiotic use, which point should the nurse emphasize to most effectively prevent antibiotic resistance?
When educating a patient about responsible antibiotic use, which point should the nurse emphasize to most effectively prevent antibiotic resistance?
Which laboratory result is most indicative of an active bacterial infection?
Which laboratory result is most indicative of an active bacterial infection?
A patient in airborne isolation requires transport to radiology for a chest X-ray. What is the priority nursing action to prevent airborne transmission during transport?
A patient in airborne isolation requires transport to radiology for a chest X-ray. What is the priority nursing action to prevent airborne transmission during transport?
What is the primary role of phagocytosis in the body's defense against infection?
What is the primary role of phagocytosis in the body's defense against infection?
A patient is diagnosed with a fungal infection. Which class of medications would the nurse anticipate being prescribed?
A patient is diagnosed with a fungal infection. Which class of medications would the nurse anticipate being prescribed?
Flashcards
Pathogen
Pathogen
An organism that can cause disease in a host.
Colonization
Colonization
Pathogenic microbes present in the body without causing symptoms or a detectable immune response.
Infection
Infection
When a microbe multiplies within a host, potentially causing illness.
Bacteria
Bacteria
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Aerobic Bacteria
Aerobic Bacteria
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Anaerobic Bacteria
Anaerobic Bacteria
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Rickettsiae
Rickettsiae
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Viruses
Viruses
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Dormant
Dormant
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Fungi
Fungi
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Protozoa
Protozoa
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Helminths
Helminths
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Prions
Prions
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Reservoir
Reservoir
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Portal of Exit
Portal of Exit
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Mode of Transmission
Mode of Transmission
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Direct Contact
Direct Contact
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Droplet Spread
Droplet Spread
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Vehicle-borne Transmission
Vehicle-borne Transmission
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Vectorborne Transmission
Vectorborne Transmission
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Airborne Transmission
Airborne Transmission
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Portal of Entry
Portal of Entry
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Virulence
Virulence
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Skin Defense
Skin Defense
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Cilia
Cilia
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Gastric Acid
Gastric Acid
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Antibodies
Antibodies
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Leukocytes
Leukocytes
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Phagocytosis
Phagocytosis
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Lysozymes
Lysozymes
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Interferon
Interferon
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Vascular Response
Vascular Response
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Inflammatory Exudate
Inflammatory Exudate
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Purulent Exudate
Purulent Exudate
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Sepsis
Sepsis
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Epidemic
Epidemic
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Pandemic
Pandemic
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Immunity
Immunity
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Herd Immunity
Herd Immunity
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Community-Acquired Infection
Community-Acquired Infection
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Health-Care-Associated Infection (HAI)
Health-Care-Associated Infection (HAI)
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Hand Hygiene
Hand Hygiene
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Asepsis
Asepsis
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Medical Asepsis
Medical Asepsis
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Surgical Asepsis
Surgical Asepsis
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Standard Precautions
Standard Precautions
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Transmission-Based Precautions
Transmission-Based Precautions
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Antibiotic-Resistant Infections
Antibiotic-Resistant Infections
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Bactericidal Agents
Bactericidal Agents
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Bacteriostatic Agents
Bacteriostatic Agents
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Study Notes
Infection Process
- A pathogen causes disease in a host.
- Colonization occurs when pathogens are present without causing symptoms or an immune response.
- Infection occurs when a microbe multiplies within a host.
- Subclinical infection involves an immune response without symptoms.
- Preventing infection involves breaking the chain of infection.
Infectious Agents
- Microorganisms include bacteria, viruses, fungi, protozoa, helminths, and prions.
- Normal flora are harmless, nonpathogenic organisms naturally present in the body.
- Intestinal flora aids in vitamin K production.
- Bacteria can become pathogenic if they enter other areas of the body.
Bacteria
- Single-celled organisms that can live and reproduce inside or outside a host.
- Most bacteria have cell walls susceptible to antibiotics but can mutate to survive.
- Bacteria are named by shape: coccus (spherical), bacillus (rod), and spirillum (spiral).
- Bacteria are classified by staining properties, such as Gram method and acid-fast staining.
- Gram-positive bacteria stain purple, Gram-negative stain pink, and acid-fast keep purple stain.
- Aerobic bacteria need oxygen to live (e.g., on the skin), while anaerobic bacteria do not (e.g., in the GI tract).
- Most bacteria grow best at 98.6°F (37°C).
- Rod-shaped bacteria form spores, which are hard to kill and remain dormant until favorable conditions arise.
- Bleach kills C. difficile spores in patient rooms.
- Rickettsiae are tiny bacteria that reproduce inside living cells and are transmitted by infected fleas, ticks, mites, and lice
Viruses
- Viruses are smaller than bacteria and depend on host cells to reproduce.
- Invaded cells produce more virus material, released by destroying the host cell or forming buds.
- Viruses may trigger disease immediately or remain dormant for years.
- Human herpesvirus 3 (varicella-zoster virus) can cause chickenpox or shingles.
- Antiviral drugs decrease viral load and symptoms, but antibiotics do not work against viruses.
Fungi
- Fungi include yeasts and molds that can produce resistant spores.
- Normal flora include many fungi in the mouth, skin, vagina, and intestinal tract.
- Most fungi are nonpathogenic in healthy people.
- Antifungal medications are available for serious fungal infections.
Protozoa
- Single-celled parasitic organisms that live in the soil.
- Infection happens through fecal-oral contamination, ingestion of contaminated food or water, host-to-host contact, or insect bites.
Helminths
- Wormlike parasitic animals, including roundworms, flatworms, tapeworms, pinworms, hookworms, and flukes.
- Disease transmission occurs through skin penetration of larvae or ingestion of helminth eggs.
- Trichinosis is transmitted by eating raw or undercooked meat containing Trichinella larvae.
Prions
- Prions are transmissible pathogenic agents that cause abnormal folding of normal cellular prion proteins, mainly in the brain which results in damage.
- Prion diseases have long incubation periods, are rapidly progressive, and fatal
- Prion diseases include classic and variant Creutzfeldt-Jakob disease.
Reservoir
- A reservoir is where infectious agents live, multiply, and reproduce
- These can be animate (people, insects, animals, plants) or inanimate (water, soil, medical devices).
Portal of Exit
- The path by which the infectious agent leaves its reservoir.
Mode of Transmission
- The direct or indirect means of transfer to a susceptible host.
Direct Transmission
- Happens through direct contact or droplet spread and includes touching, kissing, or sexual intercourse.
- Illnesses include scabies, infectious mononucleosis, and STIs.
- PPE includes gloves and gowns for contact precautions.
- Droplet spread occurs over short distances from spray when sneezing, coughing, or talking.
- Illnesses include COVID-19, influenza, and pertussis.
- PPE for COVID-19 includes fitted respirator mask, eye protection, face shield, gloves, and gown.
- Droplet PPE for non–COVID-19 infectious conditions includes surgical mask, face shield or goggles, and gloves plus standard precautions
Indirect Transmission
- Vehicle-borne, vectorborne, or airborne.
- Vehicles include biological products (blood, organs), soiled bedding, food, instruments, toys, water, and wound dressings.
- Vehicle-borne illnesses include influenza, norovirus, and hepatitis; SARS-CoV-2 is rarely transmitted this way.
- Prevention includes screening of biological products, hand hygiene, clean water/food supplies, and cleaning of patient environment and instruments.
- Vectorborne transmission spreads infectious agents through living sources other than humans, such as fleas, mice, mosquitos, rats, and ticks.
- Illnesses include Lyme disease, malaria, plague, and Zika virus.
- Reducing vector transmission involves avoiding infested areas, using insect repellents, and rodent control.
- Airborne transmission occurs by dust or droplet nuclei carrying an infectious agent through the air which can then be inhaled.
- Illnesses include TB, rubeola (measles), and varicella-zoster (chickenpox).
- SARS-CoV-2 may be transmitted through the air in poorly ventilated spaces and from aerosol-generating procedures.
- Prevention requires a HEPA respirator.
Multiple Modes of Transmission
- Diseases can be transmitted through multiple modes, like chickenpox (direct, indirect, and airborne).
- COVID-19 can also be transmitted in several ways, although direct contact is the most common.
Portal of Entry
- Organisms enter through blood, genitourinary tract, GI tract, mucous membranes, skin, placenta, or respiratory tract.
- Host condition and organism virulence determine if disease occurs.
Susceptible Host
- Factors increasing susceptibility to infection include burns, chronic disease, immunocompromised state, invasive procedures, malnourishment, stress, and age.
- Older adults may not show fever as a sign of infection, so watch for changes in behavior or symptoms masked by chronic conditions.
Human Body’s Defense Mechanisms
- Intact skin and mucous membranes are the first line of defense.
- Skin acidity and normal flora impair pathogen growth.
- Cilia trap particles in the upper respiratory tract.
- Gastric acid destroys organisms in the stomach.
- Antibodies identify foreign antigens for destruction.
- Leukocytes (WBCs) protect against infection and tissue damage.
- Neutrophils ingest and destroy bacteria and fungi
- Lymphocyte functions include antigen recognition and antibody production.
- Monocytes become macrophages and mainly ingest and destroy tissue debris and large foreign particles.
- Eosinophils destroy parasites and respond in allergic reactions.
- Basophils are involved in inflammatory and allergic reactions
- Phagocytosis is when neutrophils and macrophages engulf and digest foreign antigens.
- Lysozymes are antibacterial enzymes in WBCs and body fluids that dissolve bacteria.
- Interferon is released by WBCs and fibroblasts to help destroy virus-infected cells and inhibit virus production.
- The inflammatory response occurs with any injury, causing vasodilation, increased blood flow, and permeability.
- Purulent exudate (pus) contains protein, cellular debris, and dead leukocytes forms during phagocytosis.
- The immune system is the body’s final defense against infection.
Risk Factors for Infection
- Include aging, chronic disease, dysphagia, environment, immobility, immunocompromise, incontinence, instrumentation, invasive procedures, malnutrition, and medications.
- Older adults are at risk for respiratory infections, HAIs, hepatitis, MRSA, sepsis, skin infection, and UTIs.
Infectious Disease
- Localized infection is caused by an increase of microbes in one area.
- Signs and symptoms: pain, redness, swelling, and warmth.
- Fever of 100.4°F (38°C) may occur.
- Sepsis is life-threatening organ dysfunction caused by dysregulated host response to infection.
Laboratory Assessment
- Gram stain helps identify bacteria under a microscope (purple for Gram-positive, pink for Gram-negative).
- Culture and sensitivity (C&S) identifies the organism and the most effective antibiotic.
- Serum antibody test measures reaction to an antigen (not always indicative of active infection).
- Complete blood cell count with differential (CBC with diff) measures levels of the five leukocytes; specific elevations depend on the type and severity of the pathogen.
- Erythrocyte sedimentation rate (ESR) is an early screening test for inflammation.
- Other tests include x-rays, CT, MRI, and skin tests (e.g., PPD for TB).
Pandemic
- An epidemic is a rapid rise in the number of those with a specific infection.
- A pandemic is when an infection affects large numbers of people across multiple continents or worldwide, often due to a new infectious disease with no immunity or cure.
- Vulnerable populations include the very young/old, immunosuppressed, those with comorbidities, and those in institutions.
- Health-care workers are at high risk
Immunity
- Natural immunity occurs in species and prevents one species from contracting illnesses found in another species.
- Innate immunity is genetic; hereditary immunity is that which a person is born with
- Acquired immunity is obtained either actively or passively through exposure to an organism, from a vaccine, or from an injection of immunoglobulins (antibodies) or is passed from mother to baby.
Herd Immunity
- Herd immunity to a specific disease occurs when a significant portion of the community becomes immune to the disease through infection or vaccination. Herd immunity offers some protection to those who have not had the disease or been vaccinated.
Types of Infectious Diseases
- COVID-19:
- Caused by SARS-CoV-2, creating a pandemic due to it being a new virus
- Variants include Delta and Omicron.
- Ebola Virus Disease:
- Discovered in 1976 near the Ebola River.
- Survivors develop antibodies that last about 10 years.
- Zika Virus Disease:
- Discovered in the Zika Forest of Uganda in 1947
- Most people are protected from future infections once infected.
- Infectious Mononucleosis (IM):
- Caused by the Epstein-Barr virus (EBV), it is spread through contact with saliva or mucus.
- Mostly symptomatic in teens or young adults.
- Adults usually have antibodies by age 40.
- Incubation period is 4 to 6 weeks.
- Symptoms include fever, sore throat, and lymphadenopathy (enlarged lymph nodes in two different sites other than inguinal nodes)
- Spleen enlarges 50% of the time.
- No specific treatment; antiviral drugs are not effective.
Infection Control in the Community
- Global monitoring and virology surveillance support early virus identification.
- WHO and CDC teach standards to prevent, monitor, and control disease outbreaks.
- Local health departments teach prevention and help control outbreaks.
- Immunization programs have helped to reduce communicable diseases.
Infection Control in Health-Care Agencies
- A community-acquired infection is one a patient already has.
- A health-care-associated infection (HAI) develops as a result of care provided in a health-care agency.
- Risk factors include debility, malnourishment, immunocompromise, and multiple antibiotic therapy.
- High-risk patient care areas include burn, critical care, dialysis, neonatal, and oncology units.
- Common HAI pathogens include E. coli (UTIs), S. aureus (surgical wound infections), and P. aeruginosa (pneumonia).
Hand Hygiene
- The single-most effective way to control and prevent infection spread
- Removes transient organisms that cause most HAIs.
- Hands must be cleansed before and after every patient contact; use of gloves necessitates hygiene before and after use.
- Alcohol-based hand rubs (at least 60% alcohol) can be used if hand washing is not possible, except for C. difficile or visibly soiled hands.
- Follow CDC guidelines: wet hands, soap and lather for 20 seconds, interlace fingers, clean under nails, rinse, and dry with paper towels.
- CDC campaigns: Clean Hands Count (HCP adherence) and Life Is Better with Clean Hands (community hand washing).
Asepsis
- Asepsis is freedom from organisms.
Medical Asepsis
- Clean technique aimed at reducing pathogens and preventing transmission.
- Achieved through hand hygiene, PPE, special ventilation, disinfectants, and precautions.
- Keep body, clothing, and shoes clean to prevent infection spread.
Surgical Asepsis
- Sterile technique refers to an area free of all microorganisms and spores.
- Used in surgery and to sterilize equipment through intense heat or chemical disinfectants such as autoclaves.
- Sterilized items are dated, packaged, and sealed; sterility is voided after opening or expiration.
Ultraviolet Environmental Disinfection
- Uses UV light to disinfect patient care areas and rooms after traditional cleaning
Infection Prevention and Control Guidelines
- CDC guidelines for infection control and isolation precautions are used in policies at hospitals, long-term care facilities, and other health-care agencies.
- Standard precautions are used for all patients, assuming everyone is infectious.
- Transmission-based precautions are for specific infectious diseases, adding protection to standard precautions.
Standard Precautions
- Assume all patients are infectious and use PPE.
- Apply to blood, secretions, excretions, open skin, mucous membranes, and all body fluids except sweat.
- Includes hand hygiene, gloves, masks, eye protection, face shields, and gowns.
Transmission-Based Precautions
- Used for patients with specific infectious diseases
- Airborne precautions: private room with regulated airflow, keeping door closed. Wear fit-tested N95 respirator or PAPR.
- Limit patient transport, surgical mask on patient.
- Droplet precautions: private room (or separation >3 feet).
- Wear respirator (N95 mask or PAPR for patients with COVID-19).
- Limit patient transport; appropriate mask on patient.
- Contact precautions: private room or place with patient with same infection and no other infection.
- Gloves, gown, and foot covers protect self and others from contaminated items.
- Limit patient transport and dedicate the use of noncritical patient care equipment to a single patient.
Prevention of Respiratory Tract Infections
- Strategies to prevent infections such as ventilator-associated pneumonia (VAP) are “bundled” together.
Prevention of Genitourinary Tract Infections
- Most common HAI is catheter-associated UTI (CAUTI).
- Avoid unnecessary urinary catheters.
- Use sterile technique for insertion and care, anchor tubing to prevent movement, do not open closed drainage system, and position drainage bag below bladder level.
- For long-term catheterization, intermittent catheterization is preferred to reduce infection risk.
Prevention of Surgical Wound Infections
- Initial dressing is applied using sterile aseptic technique in the operating room.
- Monitor the wound with each dressing change for signs of infection.
Antibiotic-Resistant Infections
- A worldwide health concern with 18 antibiotic-resistant organisms.
- CDC’s Antibiotic Resistance Solutions Initiative aims to detect, respond, contain, and prevent resistant infections.
- Antibiotics kill bacteria, not viruses.
Methicillin-Resistant Staphylococcus aureus (MRSA)
- A serious, life-threatening antibiotic-resistant infection; happens from long-term use of unneeded antibiotics
- Symptoms are painful warm red bumps, fever, and drainage that can also appear as a skin boil
- Treatment involves draining skin boils or antibiotics such as vancomycin hydrochloride
- Strict contact precautions are needed.
Vancomycin-Resistant Enterococci (VRE)
- Common in normal GI and female genital tracts; VRE is a pathogenic strain.
- Transmitted via direct or indirect contact.
- Risk factors: indwelling catheters, immunocompromise, multiple antibiotics, surgical patients, and extended hospital stays.
- Prevention: proper hand hygiene, education, aggressive infection control, and restricting vancomycin.
- Treatment: combination antibiotic therapy.
Therapeutic Measures for Infectious Diseases
- The medication of choice must be able to destroy (or control) the identified pathogen otherwise it is ineffective.
- Antibiotics treat bacterial infections only.
- Antiviral medications control symptoms of viral infections.
- Antifungal drugs address fungal infections, but extended use may be needed.
- Bactericidal antibiotics kill bacteria, while bacteriostatic agents inhibit bacterial growth.
- Verify patient allergies before giving antibiotics.
- Monitor antibiotic serum peak and trough levels to ensure nontoxic, therapeutic levels in disorders of the liver and kidneys.
Antibiotic-Associated Diarrhea (AAD)
- Antibiotics upset the balance of natural microbiota
- Clindamycin, ampicillin and cephalosporins are the most common causes.
Clostridioides difficile
- A gram-positive bacterium causing infection resulting in diarrhea, fever, bloating, and abdominal pain.
- Can cause pseudomembranous colitis, a serious condition with fever, diarrhea, and abdominal pain.
- Transmitted by the fecal–oral route from touching feces-contaminated surfaces.
- Hand washing is essential, as alcohol-based rubs are not effective.
- Treatments are discontinuing the antibiotic and giving fidaxomicin or vancomycin.
Fecal Microbiota Transplantation
- Can cure recurrent CDI by restoring healthy bacteria in the intestine.
- Transplanted via oral capsules, colonoscopy, sigmoidoscopy, enema, nasogastric or nasoenteric tube, or EGD from a screened healthy person
Nursing Care
- Nurses administer medications correctly and teach proper medication use.
- Verify patient allergies, obtain ordered culture samples before anti-infectives, and monitor side effects, allergic response, and peak/trough results.
- Observe and report signs of superinfection.
Nursing Process for the Patient with an Infection
- Early detection of signs/symptoms and emotional support are crucial.
- Those prone to infection should take special precautions.
- Nursing Diagnoses include: Risk for Infection and Deficient Knowledge
Respiratory Tract Infection
- Symptoms: cough, nasal congestion, chest congestion, chest pain, or sore throat.
- Lung sounds: crackles, rhonchi, or wheezing.
- Sputum culture to identify pathogens.
- Encourage fluids, coughing, and deep breathing.
- Provide pain relief and oral care with toothbrush and fluoride toothpaste rather than toothettes,
- Use sterile water for oral care for immunocompromised patients.
- Elevate head of bed 30 degrees or more when a tube feeding is infusing.
Gastrointestinal Tract Infection
- Symptoms: anorexia, cramping, diarrhea, nausea, and vomiting.
- Monitor dehydration signs, stool cultures.
- Encourage fluid intake, follow standard and transmission-based precautions.
- Teach hand hygiene with antimicrobial soap and water, because other alcohols, chlorhexidine, iodophors, and other antiseptic agents are not effective in destroying C. difficile spores.
Genitourinary Tract Infection
- Symptoms: voiding urgency, frequency, and burning, flank pain, change in urine color, foul urine odor, and confusion or change in mental status in older adults.
- Monitor urine frequency, amount, color, and odor and get urinalysis and urine cultures.
- Avoid urinary catheters unless needed.
- Use sterile technique for urinary catheters and avoid contamination when emptying the bag.
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