Concept of Infection NURS 1100 2024 PDF

Concept of Infection Marta Sanderson, MSN, RN NURS 1100 Fall 2024  Class Objectives The student will be able to: 1.Describe the process of infection. (CLO #2, 6) 2.Categorize infection by causative organism and mode of transmission. (CLO #8, 9,1 0) 3.Explain the relationshi...

Concept of Infection Marta Sanderson, MSN, RN NURS 1100 Fall 2024  Class Objectives The student will be able to: 1.Describe the process of infection. (CLO #2, 6) 2.Categorize infection by causative organism and mode of transmission. (CLO #8, 9,1 0) 3.Explain the relationship between the chain and transmission of infection. (CLO # 8, 9, 10) 4.Discuss the consequences of infection. (CLO # 7) 5.Identify the body's innate defense mechanism and nursing care that promotes maintaining these barriers. (CLO# 1, 2, 7, 8) 6.Identify clients with risk for infection. (CLO # 2, 7) 7.Describe conditions that promote the transmission of healthcare-acquired infections. (CLO # 2, 3, 7) 8.Demonstrate Standard Precautions and Transmission-Based Precautions. ( CLO # 6, 7, 9) 9.Demonstrate good hand hygiene. (CLO # 1, 7, 8, 9) 10.Discuss and employ strategies to limit spread of conjunctivitis, cellulitis, human papilloma virus, and corona-SarsV-2 virus. (CLO #1, 2, 6, 9, 10) Definition of the Concept of Infection Giddens (p.230) “the invasion and multiplication of microorganisms in the body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response.”  Infectious Disease versus Communicable Disease Infectious Disease: caused by pathogens invading the host, colonizing, and stimulating the inflammatory response to produce host symptoms. Communicable Diseases: infectious diseases that are transmitted by contact from a source to a susceptible host. Tetanus in soil can infect the host but cannot be transmitted to another human. It is an infectious disease (preventable) but is not a communicable disease.  More semantics:.  Infection versus Colonization.  Bad…worse…ugly Endemic: constant presence in a geographical area Epidemic: exceeds usual frequency in geographical area Pandemic: global epidemic  Most Common Infections Globally.  Sexually Transmissible Diseases.Why? Less condom use Substance Use Disorders Multiple Partners/ New dating Patterns In 2021, Georgia ranked 5th in the U.S. in report of new HIV infections (CDC, 2022). GA: Chlamydia #7, Gonorrhea #19, Syphilis #8, Congenital syphilis #16 Underserved, lack of access  2 ways bacterial pathogens affect humans.  Bacterial Pathogens. Opens up arterial wall and fluid leaks into interstitial tissue Blood brain barrier Viruses  Viral infection becomes Bacterial.  Parasitic Protozoan Infections. Giardia, for example A parasite lies in or on the host, gets its food and water at the host’s expense, encroaches on normal flora. Most contagious  Infection at it’s worse: Sepsis.  SIRS Criteria. Lactic Acid >2 Immunity: Resistance to Pathogens Infection vs INFECTION  Herd Immunity Herd immunity (or community immunity) occurs when a high percentage of the community is immune to a disease (through vaccination and/or prior illness), making the spread of this disease from person to person unlikely. (CDC, 2020) All is normal…then infection occurs Normal flora Microorganisms 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. Body system defenses Organs Inflammation Signs of local inflammation and infection are identical. Vascular and cellular responses Exudates (serous, sanguineous, or purulent) Tissue repair  Innate Immunity.  Humoral Response: B cells.  Immune Response: T Cell Mediated.  CDC Global Plan.  Vector-borne Infections In our region and the Northeast region of the U.S., vector-borne disease transmitted by ticks and mosquitos is common. In groups of 6-7, discover what is included in community campaigns to decrease contraction of vector-borne disease. How would you educate community clients? 10 minutes  Infection Prevention: Immunization.  Promote Resistance. Also: proper nutrition with glycemic control modify factors that reduce immunity: smoking, ETOH, drugs,  CDC: ‘Break the Chain’.  We are the ‘Chain Breakers’. Hospital acquired infections: #3 cause of U.S. death until 2020-2021 it was covid & other HAIs #4.  Human cost & cost of HAIs Direct medical costs In the United States, the direct medical costs of HAIs in hospitals are estimated to be between $28.4 billion and $45 billion annually. Indirect costs HAIs also cause an additional $12.4 billion in costs to society due to early deaths and lost productivity. Longer hospital stays HAIs can cause patients to stay in the hospital longer, which can increase costs. One study found that patients with an HAI had a length of stay that was double that of patients without an HAI  MDROs. Take all antibiotics prescribed Clostridium difficile Clostridium difficile  Healthcare Worker Prevention Strategies.  Perpetual Strategy.  When?.  CDC Handwashing Guidelines. Friction required. Completely Dry  Foam Sanitizers Takes >20 seconds to rub in. Takes > 30 seconds to dry. CDC reports: Correctly done only 4% of the time. Let’s do it together! Handwashing only with visibly soiled hands and handling fecal material  Nurse Fomites Stethoscopes: Infected as hands! 85% coagulase negative staph; C. diff Only 4% clean after each use. Cell Phones: Cultures matched in-pt rates. E. coli and MRSA. Source of community pathogens into healthcare. Clean with foam sanitizer. Uniforms: 42,82 fcu/cm2 = highly present. Wash immediately at home and with each wear.  Surface Fomites.  Fomite Patrol In groups, discuss all the fomites your group can think of that may be encountered in an acute care health unit. Plan how to break the chain of infection regarding 3 fomites (not the ones we have already discussed)  Every client, every time.  Special Precautions. No Cohorts Tier 1 Precautions: P&P Table 28.1, p. 468 Tier 2 Precautions: P&P Table 28.1, p. 468 Streptococcal pharyngitis  Visitor Patrol In groups: The team is working on a Medical-surgical floor. Several clients have infections and have visitors. What education will the team give them regarding PPE. Describe dressing the visitor. Room 201 Mr. Hall….dx. Tuberculosis Room 213 Ms. Vance….C. diff Room 216 Mr. Leon…HIV Room 223 Child Bonnie….streptococcal pharyngitis  Gown Wear.  Why Masks?.  Which Mask?.  Interdisciplinary Goals.  Rapid Diagnosis.  Rapid Treatment Medication – specific therapy for a specific infectious disease. Antibiotics – used to treat bacterial infections Antibiotics are selected based on the organism being treated (gram-negative or gram-positive) Broad spectrum antibiotics treat both gram positive and gram negative bacterial infections Antivirals – kills a virus or suppresses its ability to reproduce  Antifungals – treat fungal infections Antiparasitics – treat parasitic infections and can be as toxic as the parasite they are intended to remove.  Medications.  Exemplar (Viral) HPV (human papilloma virus) is an STD that affects mucus cells that give rise to cancer 20 million affected in U.S. 39,000 HPV related cancers are diagnosed in U.S. yearly (cervical, vulvar, neck & throat, and anal cancers) 91% cervical and anal cancers are caused by HPV 70% oropharyngeal cancers are caused by HPV, now exceeding smoking related causes, exceed HPV cervical cancers, >75% in males HPV is preventable by immunization (American Cancer Society, 2016; CDC 2016) HPV Virus HPV Vaccination Schedule  Cellulitis What causes cellulitis? Cellulitis is mainly caused by two bacteria: Staphylococcus aureus and beta-hemolytic streptococcus. We all have bacteria, including these, living harmless on our skin. Cellulitis occurs if the skin is broken and the bacteria can delve down deep into the skin layers. Who gets cellulitis? Are elderly. Have swollen legs (for various reasons) or are overweight or obese. Have previously had an episode of cellulitis. Have a weak immune system - for example, if you take steroids or chemotherapy. Are pregnant. Have poorly controlled diabetes. Are an intravenous drug user. Have severe eczema or other skin conditions that cause cracks in the skin, like athlete's foot. https://www.youtube.com/watch?v=HnHwyWmTbLw Covid 19 or SARS COV 2  Covid 19 or SARS COV 2 Alpha, Beta, Delta, and Omicron Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-Cov-2), a new enveloped RNA virus known as Coronavirus (COvID-19). Now 4 main variants. Initially presented as pneumonia-like illness in a group of people in Wuhan, China. Initial spread to U.S. primarily through Europe. The current mortality rate 1.6%. >30% Latina & African American in US Was less symptomatic in children 10 similar statistics as adults. Omicron variant now most prominent, more infectious. South Africa Risk: >65, CVD, DM, immunosuppressed, lung disease, those with healthcare disparities Herd immunity has not yet developed. ***will happen only when virus infects 60% of population get infection and are asymptomatic  Covid 19 or SARS COV 2 #1 goal: Reduce opportunity for transmission: masks, social distancing, no crowds, early testing, vaccination (70% in U.S. fully vaccinated) Mild symptoms: quarantine and treat symptoms such as fever Moderate symptoms: support resp. symptoms. Ex. Supplemental O2 Severe symptoms: treated as MSOF. Ventilatory support with proning, VTE and micro-clotting prevention (heparin), steroids, CV monitoring & support, anti-virals (Remdesivir),monoclonal antibodies(Xeljanz, Enbrel), convalescent plasma Convalescence: Variety of sequala. Long-haulers syndrome Covid 19 or SARS COV 2: 9/21 CDC CPG 2022 NIH CPG for Non-Hospitalized Covid Clients 2022 NIH CPG for Hospitalized Clients  Statin Therapy in Covid “Our findings indicate that the lower risk of statins on hospitalization for COVID‐19, although modest, is robust. Statins are now known to be beneficial in primary prevention, decreasing all‐cause mortality, cardiovascular disease, coronary heart disease, and stroke. Furthermore, there is no evidence of any serious harm caused by their use.103 Our study found an additional lower risk of statins against serious COVID‐19 symptoms that lead to hospitalization. Since the beginning of the COVID‐19 pandemic, many clinicians have suggested that statins could be used as an adjunctive treatment for the SARS‐CoV‐2 infection. This population‐based matched cohort study conducted in 2 million adults aged ≥40 years who used statins for the primary prevention of cardiovascular diseases compared with 2 million nonusers supports the hypothesis that statin use is associated with a lower risk of hospitalization for COVID‐19. All types of statins showed a similar effect.”  Case Study A 44-year-old client presents with severe, bronchitic cough, fever, and neck pain for 2 days. No previous medical history or allergies. VS: 102/60, HR 112/BPM, RR 24/min, SaO2 92%, Temp. 102.4 Prioritize you first actions. Test results: WBC 32,000, Lactic acid 3.0, + lumbar puncture tests What Tier Transmission Precautions will you use? A 57-year-old female is admitted to the hospital with a upper left arm open wound infection (MRSA) and cellulitis. Use an x to indicate whether the nurse’s actions are indicated (appropriate), contraindicated (can cause harm), or non-essential. Nursing Actions Indicated Contraindic Non- ated essential Place the client on Contact Precautions Apply cold compresses to the upper left arm Elevate the client’s left arm on a pillow Take a wound culture every shift to determine if the infection Is improving Initiate IV access to administer IV Fluids & antibiotics Administer subcutaneous heparin (enoxaparin) A 57-year-old female is admitted to the hospital with a upper left arm open wound infection (MRSA) and cellulitis. Use an x to indicate whether the nurse’s actions are indicated (appropriate), contraindicated (can cause harm), or non-essential. Nursing Actions Indicated Contraindic Non- ated essential Place the client on Contact Precautions x Apply cold compresses to the upper left arm X warm Elevate the client’s left arm on a pillow x Take a wound culture every shift to determine if xNO, once the infection Is improving Initiate IV access to administer IV Fluids & x antibiotics Administer subcutaneous heparin (enoxaparin) x