NUR1128 Lecture Notes PDF

Prac%cal Nursing Skills 1 Notes Topic 1 - Infection and prevention control Healthcare-associated infec1ons (HAI) Refer to infec%ons associated with healthcare delivery in any se;ng o Hospitals o Long-term care facili%es o Community and ambulatory se;ngs o Home...

Prac%cal Nursing Skills 1 Notes Topic 1 - Infection and prevention control Healthcare-associated infec1ons (HAI) Refer to infec%ons associated with healthcare delivery in any se;ng o Hospitals o Long-term care facili%es o Community and ambulatory se;ngs o Home and community care o A total of 8.9 million HCAIs were es%mated to occur each year in european hospitals and long term care facili%es combined. o More than half of certain HAIs are considered preventable Defeni1on o A localised or systemic infec%on that results from an adverse reac%on to the presence of an infec%ous agents or its toxin, for which there is no evidence of infec%on on admission to a health care facility o An infec%on is frequently considered a HAI if its apperars > 48 hours aNer admission Pa1ent safety – FACTS 1. In developed countries – 1 in 10 pa%ents are harmed while recieving healthcare. 2. Harm caused by a range of errors or adverse events 3. Industries with a percieved higher risk such as avia%on and nuclear plants have HAI increase hospital costs o HAI delays pa%ent discharge o Blocks beds o Increases treatment costs o Increase the number of inves%ga%ons o HAI is oNen the subject of li%ga%on, the costs of which may be very large Major types of HAI o Catheter- associated urinary tract infec%on (CAUTI) o Hospital acquired pneumonia (HAP) / Ven%lator- associated pneumonia (VAP) o Surgical Site Infec%on (SSI) o Catheter related bloodstream infec%on (CR – BSI) 1  Prac%cal Nursing Skills 1 Notes 3 main factors related to development of HAIs 1. Host factors 2. Agent factors 3. Environmental factors 1. Host factors Coma HIV infec%on Malignancies Diabetes mellitus Severe malnutri%on Circulatory impairment Open wound or trauma Bronchopulmonary disease Advanced age or premature birth severe burns and certain skin diseases Chronic obstruc%ve pulmonary disease Immunodeficiency (due to drug, or irradia%on) 2. Infec1ous agent A micro--organism that is capable of causing disease (pathogen) An infec%ous agent can be bacteria, virus, fungus, or parasite The majority of HAIs are caused by bacteria or viruses Two major types of bacteria that cause HAIs o Gram-posi%ve cocci (e.g., Staphylococci and Streptococci) o Gram-nega%ve bacilli (e.g., Acinetobacter, Pseudomonas, Klebsiella) For transmission to occur, the agent must remain viable un%l contact with a host is sufficient to allow infec%on. MDROs ESBL Enterobacterales that produce enzymes called extended--spectrum beta--lactamases (ESBLs). ESBL enzymes break down and destroy some commonly used an%bio%cs, including penicillins and cephalosporins, and make these drugs ineffec%ve for trea%ng infec%ons. Carbapenems usually only treatment op%on CRE Enterobacterales that produce addi%onal enzymes cause resistance to carbapenems. Very few treatment op%ons. Possibility of untreatable infec%on. 2  Prac%cal Nursing Skills 1 Notes MRSA Methicillin--resistant Staphylococcus aureus (MRSA) is a type of staph bacteria that is resistant to certain an%bio%cs called beta--lactams. Carbapenem resistant Pseudomonas aeruginosa Opportunis%c organism which can cause infec%ons in the blood, lungs (pneumonia), or other parts of the body aNer surgery. When carbapenem resistant very difficult to treat. Vancomycin resistant Enterococci Cause infec%ons in pa%ents with reduced immune response. Few treatment op%ons. 3. Environmental factors Environmental factors related to HAIs include both the animate and inanimate environment of pa%ents. o The animate environment: health care personnel, other pa%ents in the same unit, families, and visitors. o The inanimate environment: medical instruments and equipment and environmental surfaces. o Other risk factors associated with the health care environment: cleanliness of the unit, temperature and humidity, and diagnos%c and therapeu%c manoeuvres. Diagnos%c and therapeu%c procedures can increase the risk of acquiring HAIs, par%cularly 1) those transec%ng contaminated/infected %ssues or involving inser%on of a foreign body; 2) indwelling catheters, especially intravenous and urinary catheters; 3) tracheostomy or tracheal intuba%on, assisted respiratory ven%la%on, anaesthesia; 4) dialysis; 5) transfusion; 6) immunosuppressive drugs, an%microbials, hyperalimenta%on; and 7) radia%on therapy. Invasive devices: intuba%on tubes, catheters, surgical drains, and tracheostomy tubes, all by--pass the pa%ent’s natural defence mechanisms and provide an easy route for infec%on. The longer a device is leN in place, the greater the risk of infec%on A pa%ent’s treatment: pa%ents vulnerable to infec%on – immunosuppression and antacid treatment undermine the body’s defences, while an%microbial therapy and recurrent blood transfusions have also been iden%fied as risk factors Chain of infec1on o Infec%on results from an interac%on between an infec%ous agent and a suscep%ble host o The interac%on occurs by means of contact between the agent and the host and is affected by the environment 3  Prac%cal Nursing Skills 1 Notes o Breaking the chain of infec%on by interrup%ng transmission generally the best way to prevent HAIs Infec1ous agents A pathogen that causes an HAI Most important pathogens causing HAI are Gram--nega%ve bacteria Endogenous infec1on Caused when micro--organisms are part of the pa%ents own body flora These are infec%ons acquired from external sources Catheters: urinary/peripheral/central Poor hand hygiene Inadequate decontamina%on of equipment Staff Reservoir Defini%on: o Place in which an infec%ous agent can survive but may or may not mul%ply Common reservoirs: o Humans (e.g. chickenpox, hepa%%s B, HIV) o Animals (rabies, brucellosis, food-poisoning Salmonella) o equipment/fomites (Tetanus, Legionella, Pseudomonas) Human reservoir Human reservoir: three types persons who are ill (have signs and symptoms of disease) colonised persons (harbour an infec%ous agent but do not have an infec%on) carriers (are infected but do not show any signs or symptoms; they can transmit the infec%on to others) Colonisa%on is the presence of bacteria on a body surface (like on the skin, mouth, intes%nes or airway) without causing disease in the person 4  Prac%cal Nursing Skills 1 Notes Carrier state is the con%nued presence of a microorganism (bacteria, virus, or parasite) in the body that does not cause symptoms, but is able to be transmiled and infect other persons Colonized or infected – the difference Coloniza%on- the presence of mul%plying bacteria with no immunological host reac%on or clinical symptoms (fever, á white cell count) Infec%on- the presence of mul%plying bacteria overwhelms the host defences – clinical symptoms present Portal of exit The path by which an infec%ous agent leaves the reservoir Respiratory tract Genitourinary tract Gastrointes%nal tract Skin/mucous membrane (surgical & trauma%c wounds) Blood (directly through needles/catheters) Transplacental Modes of transmission A pathogen may be transmiled by a single route or it can be transmiled in several ways Modes of transmission are as follows: Contact transmission: direct, indirect-contact, and droplet Airborne transmission Vehicle transmission Vector-borne transmission Contact transmission Most common means of transmission Direct contact: o person--to--person spread, through physical contact o Hand hygiene is the most effec%ve way to prevent transmission Indirect contact: o contact with contaminated intermediate object o Thorough cleaning is essen%al to prevent infec%on acquired from contaminated equipment 5  Prac%cal Nursing Skills 1 Notes Direct & indirect contact – hands Staphylococcus aureus : o Staff may transmit own nasal staph to pa%ents. o Staphs may spread from pa%ent to pa%ent by staff hands Gram-nega%ve bacteria : o GNB can colonise pa%ent skin; then transmit on staff hands § eg. Klebsiella, Acinetobacter spp. Enteric infec%ons : o Faecal-oral spread via hands in community and hospital (staff) § eg shigella, rotavirus Direct and indirect contact – fomites Inanimate objects that passively carry infec%on from one site or host to another Includes surgical and other instruments Many other objects o Stethoscopes, pens, tourniquets, televisions o Books, crockery, utensils, packs of cards etc. o Medicines, disinfectants, electrode jellies, suc%on catheters, ven%lators, humidifiers, bedpans, endoscopes etc o Also considered as environmental sources Direct and indirect contact – sexual transmission Sexually-transmiled diseases (STDs) o Syphilis, gonorrhoea, chlamydia, HIV, HBV, Herpes etc etc Many of these organisms are very fragile & do not usually survive transmission on fomites such as clothing, towels, toilet seats Sexual transmission of HIV, HBV is partly by blood Direct and indirect contact – blood Several agents are transmiled by direct or indirect blood-to-blood contact o eg HIV, HBV Transmission by contact with infected blood: o From wounds, menses, human bites o In clinical specimens o Trauma%c sexual intercourse, esp. anal o In blood products (whole blood, factor VIII etc) o Through contaminated needles (IVDU, needle- s%ck injuries) 6  Prac%cal Nursing Skills 1 Notes Endemic HBV are maintained by ver%cal transmission from mother to child by blood during delivery In addi%on to blood-born perinatal transmission some infec%ons can be passed by ver%cal transmission from mother to foetus during pregnancy o eg syphilis, rubella, cytomegalovirus, toxoplasmosis Droplet transmission Large droplets generated by an infected or colonised person during coughing, sneezing, talking, suc%oning, etc. Droplets propelled a short distance 0.1mm fall to ground Small droplets