Infection Control And Prevention PDF

Infection Control and Prevention Created by Melissa Albright MSN, RN June 2022 P&P 11th edition ch 28 Nurses are essential to infection prevention and control Patients in health care setting are at risk for acquiring infection because...

Infection Control and Prevention Created by Melissa Albright MSN, RN June 2022 P&P 11th edition ch 28 Nurses are essential to infection prevention and control Patients in health care setting are at risk for acquiring infection because of lower resistance to pathogen , increased exposure to pathogens, some of which are resistant to most antibiotics, and invasive procedures. 1  Terms to know  Infection  Colonization  Communicable Disease:  Symptomatic  Asymptomatic  Acute vs Chronic  Localized infection  Disseminated infection  Systemic  Sepsis  Epidemic vs Pandemic Infection: the invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. Colonization: the presence and growth of microorganisms within a host but without tissue invasion or damage. Communicable Disease: An infectious disease that can be directly transmitted from one person to another Symptomatic: Presence of clinical signs and symptoms. Asymptomatic: Absence of clinical signs and symptoms Acute: resolves in a few days or weeks Chronic: an infection that typically lasts longer than 12 weeks and in some cases is non-curable Localized infection: Specific to one body part Systemic: affects the body as a whole or has spread throughout the body Sepsis: a common type of systemic infection, presence of pathogens in the blood or other tissues throughout the body Infectious diseases include: avian flu, West Nile virus, MRSA (in the community as well as in the health care setting) Is an example of colonization 20-30% of health people carry staph (or MRSA) in their noses without getting sick. They are carriers or colonized. 2  seasonal flu Covid-19 outbreak of swine flu over 30 years ago 2  Fungal Infections Viral Infections Common Pathogens Parasitic or Protozoal Infections Bacterial Infections Giddens Table 24.1 p. 231 Common Pathogens P&P Table 28.1 pg. 454 Infections and Common Causative Organisms Fungal: Microorganism, includes yeasts, molds and mushrooms In healthy individual do not cause disease and are contained by the body’s natural flora In immunocompromised people can lead to death Tinea pedis (Athlete's Foot), Candidiasis (Yeast Infection, Mouth, Vagina, Buttock), Histoplasmosis (in lungs), Lobomycosis, Cryptococcosis (Lung), Aspergillosis (Lung), Coccidioidomycosis (Lung), Ring Worm (Skin caused by a variety of fungi) Viral: Develop as a result of interference of normal cellular functioning of the host Destruction of the virus by the immune system also requires death of the host cell HIV, Hepatitis A,B,C or E, Human papillomavirus, Ebola Virus, Hantavirus, SARS-associated coronavirus, Coronavirus 19, Respiratory Syncytial Virus, Influenza Protozoal Parasitic: Generally infect individuals with compromised immune responses Typically found in dead material in water and soil Transmitted by fecal-oral route Giardia, Cryptosporidiosis, Balantidium, Chagas Disease, Malaria 3 Bacterial: Depend on the type of bacterial pathogen and the area of the body that is primarily invaded Methicillin-resistant Staphylococcus aureus (MRSA), Clostridium difficile (C-Diff) (most common in elderly patients being treated with antibiotics), Vancomycin –Resistant Enterococci (VRE), mycobacterium tuberculosis, Pseudomonas aeruginosa, Neisseria gonorrhoeae, Clostridium tetani (Tetanus) 3 P&P FIG 28.1 p. 453 Potter/Perry Table 28.1 common pathogens and diseases they produce and Box 28.1 modes of transmission Think about it → What do organisms need to thrive and survive? Infectious Agents: Potential of microorganisms or parasites to cause disease depends on the number of microorganisms present; Virulence (ability to produce disease); their ability to enter and survive in a host; and the susceptibility of the host. Immunocompromised: patient has an impaired immune system Can be readily transmitted unless removed using hand hygiene If visibly soiled washing or caring for a patient with a spore-borne infection (c-diff) use soap and water, otherwise alcohol-based hand product is acceptable Reservoir: A place where microorganisms survive, multiply and await transfer to a susceptible host. To thrive organisms require a proper environment, including appropriate food, oxygen, water, temperature, pH, and light. Oxygen Aerobic: require oxygen for survival Anaerobic: bacteria thrive where little or no free oxygen is available. Water A frequent place for microorganisms is moist drainage from surgical wounds pH 4  Most prefer pH of 5.0-7.0 Light Prefer dark environments Temperature Bacteriostasis: prevention of further growth of bacteria i.e. cold temperatures Bactericidal: temperature or chemical that destroys bacteria Portal of Exit: Skin (breaks in skin), Respiratory tract (sneeze, cough) Urinary Tract (in urine when infection is present) GI (Normal Flora (Live in or on an organism w/out causing illness, can be normal in one person and a pathogen in others) (emesis, bowel elimination, drainage of bile via surgical wounds or drainage tubes) Reproductive tract, Blood (HBV, HCV and HIV) Modes of transmission : Box 28.1 Modes of Transmission Contact Direct Person-to-person (fecal, oral) physical contact between source and susceptible host Health care provider, medial equipment, high-touch surfaces etc. Indirect Personal contact of susceptible host with contaminated inanimate object (needles, sharp objects, soiled linen, dressings, envirionment) Droplet Transmitted via cough or sneeze creating droplets that care germs short distances (w/in 6 ft) Can land on susceptible person’s eyes, nose, or mouth Pertussis, meningitis, Airborne Organisms are carried in droplet, suspended in air during coughing or sneezing Aerosolized by medical equipment TB, Covid-19 Vehicles Contaminated items (sharps injuries can lead to infection when bloodborne pathogens enter through a skin puncture) Water Drugs, solutions Blood Food (improperly handled, store or cooked) Vector External mechanical transfer (flies) teach patients to use bug spray to prevent diseases transmitted by these methods (Rocky Mountain spotted Fever, Lyme disease, malaria, Dengue fever etc.) Internal transmission such as parasitic conditions between vector and host Mosquito Louse Flea Tick Portal of Entry: enter through the same routes they use for exiting 4 Susceptible Host: Susceptibility: depends on an individual's degree of resistance to pathogens 4  Risk Factors    Immunodeficiency Immature or less responsive and efficient with age. Caused by genetic factors (primary immunodeficiency), malnutrition, preexisting infection with other pathogens (HIV, Epstein-Barr) acute or chronic psychological or environmental stress, use of medications, treatment for cancer Chronic Disease Diabetes mellitus, inflammatory disorders, cancers, and hepatic or respiratory disorders increase vulnerability to infection Treatment strategies that involve introduction of invasive lines, immunosuppressive medications ( corticosteroids), antibiotics or antivirals, surgery, intubation and mechanical ventilation expose body to entry of pathogenic organisms Environmental Conditions Crowded living conditions increase risk of spread Presence of clean food and water, conditions of food preparations and sufficient air ventilation 5  Infectious Process  Incubation Period  Prodromal Stage  Illness Stage  Convalescence Box 28.2 Page 456 Incubation Period: Time between entrance of pathogen into body and appearance of 1st symptom (this person is a carrier) Prodromal Stage: Time from onset of nonspecific signs and symptoms to more specific symptoms. (Patient may be capable of spreading disease to others) Illness Stage: Time when patient manifests signs an symptoms specific to type of infection. Convalescence: Time when acute symptoms of infection disappear (Recover time depends on severity of infection and host resistance) 6 Giddens Ch 24 pg. 232 An infection involves an interface with a person, the environment, and a pathogen. 7  Defenses Against Infection Normal floras Body system defenses Inflammation  Vascular and cellular responses  Inflammatory exudate  Tissue repair This Photo by Unknown author is licensed under CC BY. Normal Floras: Do not usually cause disease when residing in their usual are of the body but instead participate in maintaining health. Reside on the surface and deep layers of skin, saliva, oral mucosa and GI and GU tracts Broad-spectrum antibiotics: can cause a superinfection by eliminating normal flora that are not causing the infection Body System Defenses: Designed to protect against infection Table 28.2, p.457, presents examples: Ex. = urine flow washes away microorganisms but a urinary catheter could allow microorganisms to travel up to the bladder causing a bladder infection Ex. = cilia lining the upper airway and nose capture inhaled microbes but if this defense mechanism is damaged by smoking they won’t work to protect against infection Ex. – skin is #1 defense mechanism IF remains intact break in skin increases chance of infection. Puncture wounds are especially bad; trauma cases are “dirty” Inflammation: Vascular and Cellular Response protective vascular reaction that delivers fluid, blood products, and nutrients to an area of injury. S/S: swelling, redness, heat, pain, tenderness and loss of function to affected body part. 8  When inflammation becomes systemic s/s: fever, Increased WBCs, malaise, anorexia, nausea, vomiting, enlarged lymph nodes and organ failure Treatment: R.I.C.E. Inflammatory Exudate Accumulation of fluid, dead tissue cells and WBCs form at site of inflammation\ Serous: clear Sanguineous: containing red blood cells Purulent: contains WBCs and bacteria Usually cleared away through lymphatic system Tissue Repair Involves the defensive, reconstructive and maturative stages. Damaged cells are replaced with healthy new ones. Scar and surrounding tissue are not as strong as normal tissue. 8  Health Care Associated Infections Result From: Invasive procedures Antibiotic administration Multidrug-resistant organisms (MDROs) Breaks in infection prevention and control activities Goals of infection prevention and control Protect patients from infections Meet professional standards and guidelines Protect yourself and others from diseases Reduce the severity of illness and complications resulting from infection Health Care Associated Infections Occurs when a patient develops an infection that was not present at the time of admission. Used to be called “nosocomial infections” Ex. CAUTI Result from the delivery of health services in a health care agency Result from invasive procedures, antibiotic administration, presence of multidrug-resistant organisms (MDROs), and breaks in infection prevention and control activities. Major sites for HAIs include surgical or traumatic wounds, urinary and respiratory tracts and the blood stream Costs for treatment of HAIs are often not reimbursed. BOX 28.3 p. 458 Examples of Sites for and causes of Health care-Associated Infections Risks for patients in the health-care system includes: the number of health care professionals in direct contact with clients the type and number of invasive procedure and therapies, the length of hospitalization Community-acquired infection: is one that was present on admission to the hospital. 9 Iatrogenic infection: a type of HAI from a diagnostic or therapeutic procedure; (ex. Bronchoscopy and Tx with broad spectrum antibiotics) Exogenous infection: comes from microorganisms outside of the individual, (Ex. = Salmonella, Clostridium tetani, and Aspergillus.), these do not exist in the body’s normal flora. Endogenous infections: occur when a part of the body’s normal flora becomes altered or an overgrowth results, (Ex. = streptococci, enterococci, or yeast.) Often occur when a patient is on broad spectrum antibiotics, (Yeast infection, or thrush) 9  You notice that your clinical instructor is not washing their hands between patients. What should you do? This Photo by Unknown Author is licensed under CC BY 10  Recognize Cues (Assessment)   This Photo by Unknown author is licensed under CC BY-SA. Nursing Process: Assessment (Recognizing Cues) Hx. of previous health problems involving infection Potential risks posed in patient’s current environment BOX 28.5 Nursing Assessment Questions Through the patient’s eyes Determine how patient feels about their illness or risk for infection Does the patient have previous experience with infection Risk for Infection Nutritional status a poor intake of protein and nutrients (like carbohydrates and fat) reduces the body’s immune defenses and slows the wound healing process. Stress effects the body’s energy level and resistance to infections / their “coping ability” Disease process Ex. = diseases of the immune system like Leukemia and AIDS, diabetes (altered nutritional state), respiratory diseases like emphysema, Cancer, peripheral vascular disease (reduces blood flow to the extremities), 11  clients with burns have a very high susceptibility to infection (the greater the depth and extent of the burns, the higher the risk for infection) Status of defense mechanisms Medical therapy Ex. some chronic diseases are tx. with adrenal corticosteroids (decrease inflammation –BUT → impair the body’s natural inflammatory response); cancer drugs, medications to prevent organ rejection Travel History Lab Data Clinical Appearance Perform physical assessment including area involved in and infection as well as areas at risk for infection s/s local infection(surgical and traumatic wounds, pressure injuries, oral lesions and abscesses) redness, warmth and swelling. May be drainage (yellow, green or brown) Assess for pain and tenderness s/s systemic infection More generalized symptoms Fever, fatigue, n/v and malaise Lymph nodes may be enlarged or swollen Watch for changes in LOC and vital signs (increased body temp, HR, RR and decrease in BP) 11  Populations at Greatest Risk for Infection  *All individuals are at risk for infectious disease regardless of age, ethnicity, gender, socioeconomic status, geographic location or prior health history.  *Populations at greatest risk: Age Socioeconomic status Geographic location Uninsured or Underinsured It is important to identify patients most at risk for infection. Table 28.3 Host Characteristics Influencing Susceptibility to and Severity of Disease Status of defense mechanisms = smoker, any break in skin, meds (immunosuppressant's) Populations at greatest risk: poor, uninsured, geographic area Age: Infant has immature defenses against infection (Has mom’s immunity for 1st few weeks) Older adults have changes in their immune defense mechanisms decrease in the cell-mediated immunity; skin becomes thin tears more easily 12  Common Diagnostic Tests    Complete Blood Count (CBC) (With White  Chest x-rays Blood Cell Count (WBC) differential)  Computerized Tomography (CT)  Cultural Sensitivity  Magneti Resonance Imaging (MRI  C-Reactive Protein (CRP)  Positron Emission Tomography (PET)  Erythrocyte Sedimentation Rate (ESR)  Indium (Indium-111)  Serologic tests for the detection of a virus or antibodies Diagnostic tests Laboratory tests: CBC, C&S, CRP, ESR, and serologic tests to detect specific antibodies or viruses. Radiographic tests: x-rays, MRI, CAT, PET, and indium scans. Useful in visualizing body tissue to gain insight to possible infection or scope of infection. CBC WBC Increased in acute infection/ Decreased in certain viral or overwhelming infections Neutrophils: Increased in acute suppurative infection Lymphocytes Chronic bacterial and viral Monocytes: Protozoan Eosinophils: parasitic Basophils: Normal in presence of infection 13  Analyze Cues: (Analysis and Nursing Diagnosis This Photo by Unknown author is licensed under CC BY-SA. Potential Nursing Diagnosis Risk for Infection Impaired Nutritional Status: Deficient Food Intake Impaired Oral Mucous Membrane Social Isolation Impaired skin integrity Impaired Mobility Readiness for enhanced immunization status 14   Generate Solutions (Planning Outcomes  Identification)  This Photo by Unknown author is licensed under CC BY. Outcomes Work with patient and family to identify expected outcomes Use clinical judgement to establish realistic outcomes that align with patients expectations and preferences Interventions Purposeful Direct Measurable Setting Priorities Establish priorities for each diagnosis and related outcomes of care As patient improves priorities change In acute care environment priorities change quickly Teamwork and Collaboration Includes prevention and infection control practices include multiple disciplines Includes family caregiver, health care providers, registered dietitians, respiratory therapists, case management etc. 15  Take Actions (Implementation)     This Photo by Unknown author is licensed under CC BY-SA. Health Promotion Nutritional support, rest, personal hygiene, maintenance of physiological protective mechanisms, recommended immunizations protect patients Nutrition Vary depending on their age and condition Proper diet helps the immune system and contains a variety foods from all food groups Collaborate with a registered dietician, patient and patient’s family Hygiene Personal hygiene decreases microorganisms of the skin, maintains integrity of mucous membranes Clean from clean to dirty Immunization Follow CDC guidelines Adequate Rest and Regular Diet Physical exercise increases lung capacity, circulation, energy and endurance, decreases stress, improves appetite, sleeping, and elimination Acute Care Treatment of infectious process, eliminating infectious organisms and supporting a patient's defenses As a nurse you will implement supportive infection control measures Systemic infections: prevent complications of fever, maintain fluids, maintain adequate nutrition intake Localized infections: may require removal of debris to promote healing (irrigation, wound dressing 16  debridement [wet to dry dressing changes etc.]) Medical Asepsis Asepsis: the absence of pathogenic microorganisms Medical Asepsis: hand hygiene, use of PPE and routine environmental cleaning Sterile Technique Keep area closed off (Make sure to close doors) Limit number of people in the room Use sterile gloves Do not place any nonsterile items on the field (ex. Flushes, 2/x2 etc.) Control or Elimination of Infectious Agents (table 28.5 p. 467 Examples of Disinfection and Sterilization Processes, Box 28.8 p. 467 Categories for sterilization , disinfection, and cleaning [FYI]) Cleaning: removal of organic material (blood) or inorganic material (soil) from objects or surfaces Disinfection and Sterilization: use both physical and chemical processes that disrupt the internal function inf of microorganisms Disinfection: eliminates many or all microorganisms with the exception of bacterial spores (can be surface or high-level which is required for medical equipment such as endoscopes Sterilization: eliminates all forms of microbial life, including spores Protection of the susceptible host (Box 28.9 p. 468 Infection Prevention and Control Protecting the Susceptible Host) Control or elimination of Reservoirs of infection (Box 28.10 Infection Prevention and Control to Reduce Reservoirs of Infection) Emptying urinary drainage bags, keeping food refrigerated Use antiseptic wipes on IV tubing ports Appropriate handling and disposal of medical waste Control of portals of Exit/Entry Respiratory hygiene/cough etiquette Use standard precautions when handling body fluids Perform hand hygiene Control of Transmission Use of standard precautions Do not share bedpans, urinals, bath basins etc. Clean medical equipment (stethoscope, vital signs machine etc) in between patients using alcohol wipes Hand Hygiene (next slide) Isolation and Isolation precautions Standard Contact Droplet Protective environment 16  You can see that the nurse has a sterile glove on her right hand and is touching the glove with her bare left hand. Is the nurse breaking the “sterile-touches-sterile” principle? While donning sterile gloves, the nurse notices the edges of the glove package are slightly yellow. The yellow area is more than 1 inch away from the gloves and only appears to be on the outside of the glove package. What is the best action for the nurse to take at this point? The gloves should be thrown away because the gloves are likely to be contaminated from an outside source. Because of the yellow area, the gloves are considered contaminated. Never assume an item is sterile. If there is any doubt about its sterility, consider it contaminated. The other supplies do not have to be thrown away because they have not been contaminated. The gloves cannot be used since the sterility is in question from the yellow area. The gloves are considered contaminated. 17  Hand Hygiene This Photo by Unknown author is licensed under CC BY-SA. Principles of infection control: The most important and most basic technique in preventing and controlling transmission of infection is hand hygiene. Skill 28.1 p. 485 Antibacterial hand soaps: For routine use: can irritate the skin and kill resident flora which can lead to the development of infection Antimicrobial hand soaps: Won’t kill the “good bacterial” on the skin Hand hygiene includes: 1. Handwashing If hands are visibly soiled When there is a possibility of contact with bacterial spores 2. use of anti-septic hand wash Before entering a client room After administering medications Before performing an assessment on a newly admitted client 3. antiseptic hand rub (You must continue to rub until hands are dry) 4. surgical hand antisepsis Clinical Management 18  Primary prevention Vaccinations, hand washing, and other good hygiene Secondary prevention and screening Screening for STDs Collaborative interventions Antimicrobial therapy, rest and comfort measures, nutritional support, and disinfection of physical environment Patient Education is important == help prevent spread; ex. Productive cough = tissues == dispose properly 18  Clinical Management    This Photo by Unknown author is licensed under CC BY-NC-ND. Clinical Management Primary prevention Vaccinations, Hand washing, and other good hygiene Secondary prevention and screening Screening for STDs Pap smears Collaborative interventions Antimicrobial therapy, rest and comfort measures, nutritional support, and disinfection of physical environment 19   Standard precautions Isolation and Used in the care of all patients Isolation Precautions Prevent and control spread of infection Includes the use of PPE This Photo by Unknown author is licensed under CC BY-SA-NC. This Photo by Unknown author is licensed under CC BY. Standard precautions: 1st Tier: Standard Precautions: Apply to all patients, regardless of suspected or confirmed infection status, in any setting in which health care is delivered. Includes barrier precautions and the appropriate PPE (gowns, gloves, basks, eyewear, and protective devices or clothing) Principles and procedures to prevent and control infection and its spread Antimicrobial therapy, rest and comfort measures, nutritional support, disinfection of physical environment Developed by the Center for Disease Control and Prevention (CDC) Developed out of “Universal Precautions” that were started in the 1980’s to protect you from bloodborne pathogens (HIV, HBV, HCV) 2nd tier (Table 28.6 p 469 Centers for Disease Control and Prevention Isolation Guidelines) Designed for patients know/suspected to be colonized with microorganisms transmitted by droplet, airborne, or contact routine **Use PPE that is appropriate to prevent the spread of infection even for undiagnosed based on your critical thinking Donning PERFORM HAND HYGIENE, PUT ON GOWN, PUT ON MASK, PUT ON EYE PROTECTION, PUT 20 ON GLOVES, PPE CHECK Doffing The gloves are removed first because they are usually the most contaminated PPE and must be removed to avoid contamination of clean areas of the other PPE during their removal. The mask or face shield is removed after the gown. The hair covering, if used, is removed after the face shield. The gown is removed second. **Show and Tell PPE 20  Second Tier Isolation Precautions If patients are under isolation precautions, make sure they are provided social interaction. Contact Precautions MRSA, VRE, C-diff, wounds Use when a patient has a wound that is a concern for infection, or when cleaning a room where a patient has been discharged and had any of the above organisms. Droplet Precautions Influenza or other diseases that are transmitted by coughing, sneezing or talking and you cannot remain 6 ft away from patient. Airborne Precautions TB, Measles, Covid If you need to transport a patient on Airborne Precautions Should be limited to only when necessary Notify the department that the patient is going to Patient needs to wear a surgical mask (covering mouth and nose) the entire time they are being transported Patients who require airborne isolation are served meals on disposable dishes and trays. To dispose of the tray, the nurse inside the room must wear protective garb and place the tray and its contents inside a special isolation bag that is held by a second healthcare worker at the patient’s door. 21  Drug Classifications  Antibacterial  Penicillin  Cephalosporins (1st, 2nd, 3rd, 4th generation)  Fluroquinolones  Macrolides  Aminoglycosides  Other Anti-infective  Antiviral  Antifungal  Antiprotozoal This Photo by Unknown author is licensed under CC BY-ND. Patient education is important: Entire course of meds should be taken Ensure infection is gone Decreases resistance Even if feeling better and temp is gone 22  Governing Bodies OSHA CDC Escambia County Public Health Department OSHA (Occupational Safety and Health Administration) Publishes rules and regulations to protect employees from bloodborne pathogens n the workplace OSHA regulations & CDC guidelines: (Centers for Disease Control and Prevention) Incorporated into policies & procedures of heath care settings Needle safety (NEVER RECAP A DIRTY NEEDLE) 1st flush area with warm water and wash any wound with soap and water or antiseptic 2nd report to your supervisor 3rd seek any medical assistance and lab work 4th create an incident report Will be part of regular staff training Goals of U.S. Department of Health and Human Services are to reduce: Central line-associated bloodstream infection (CLABSI) Surgical site infection (SSI) Catheter-Associated urinary tract infection (CAUTI) Methicillin-resistant staphylococcus aureus (MRSA) infection Ventilator-associated pneumonia (VAP) Multidrug-resistant organisms (MDROs) 23  C difficile infection (CDI) and hospitalizations Escambia County Public health department Epidemiology department is responsible for the reporting and control of communicable diseases and conditions that may significantly affect public health Directly responsible for investigating over 50 reportable conditions The infection control nurse in health care settings is responsible for reporting communicable diseases to the local public health dept. 23