Communicable Diseases PDF

10/08/2024 Communicable Diseases 1 Differentiate between concepts of colonization, infection and disease. Discuss the benefits of vaccines recommended for health care workers....

10/08/2024 Communicable Diseases 1 Differentiate between concepts of colonization, infection and disease. Discuss the benefits of vaccines recommended for health care workers. Compare and contrast standard and transmission-based precautions and discuss the elements of these standards. Describe the concept and the nursing Objectives: management of a patient with infectious diseases. Explain measures that reduce the risk of infection. Apply the Nursing Process as a framework for care of patients with infectious diseases. 2 1  10/08/2024 Terms to remember! Carrier: person who has an organism without apparent signs and symptoms; one who is able to transmit an infection to others. Colonization: microorganisms present in or on a host, without host interference or interaction and without eliciting symptoms in the host. Communicable: passed from one person to another directly through touch or indirectly by using contaminated objects. Health care–associated infection (HAI): an infection not present or incubating at the time of admission to the health care setting; this term has replaced the term nosocomial infection. Host: an organism that provides living conditions to support a microorganism. Incubation period: time between contact and onset of signs and symptoms. Infection: presence and growth of pathogenic microorganism in a susceptible host. Infectious disease: the consequences that result from invasion of the body by microorganisms that can produce harm to the body and potentially death. 3 Terms to remember! Normal flora: persistent nonpathogenic organisms colonizing a host reservoir: any person, plant, animal, substance, or location that provides living conditions for microorganisms and that enables further dispersal of the organism. Pathogenic: disease producing. Standard precautions: strategy of assuming all patients may carry infectious agents and using appropriate barrier precautions for all health care worker–patient interactions. Susceptible: not possessing immunity to a particular pathogen. (lacking resistance) Transient flora: organisms that have been recently acquired and are likely to be shed in a relatively short period. Transmission-based precautions: precautions used in addition to standard precautions when contagious or epidemiologically significant organisms are recognized; the three types of transmission- based precautions are airborne, droplet, and contact precautions. Virulence: degree of pathogenicity of an organism. 4 2  10/08/2024 Colonization, Infection and Infectious Disease 5 Microorganism live in continuous interaction with the environment. Relatively few anatomic sites (e.g., brain, blood, bone, Physiology heart, vascular system) are sterile. associated Bacteria found throughout the body usually provide with infection beneficial normal flora (nonpathogenic organisms colonizing a host) to compete with potential pathogens, to facilitate digestion, or to work in other ways symbiotically with the host. It leads to the development of a complex open ecosystem formed by the interaction of resident and transiently present microbes. 6 3  10/08/2024 Resident microbes / Normal Flora (Endogenous) Microorganisms (usually bacteria) that normally exist in the body and provide natural immunity against certain infections. They are not harmful and cannot be eliminated unless using a surgical scrub technique. 7 Transient Microbes (Exogenous) Microorganisms that we acquire when we interact with other humans or our environment. Can be removed by washing or cleaning. Under some conditions, the interaction with endogenous microbes can be harmful for the host, and opportunistic infections may occur. 8 4  10/08/2024 9 Colonization VS Infection They rarely cause infection or disease in HEALTHY INDIVIDUAL. They may become pathogenic if introduced to another site within the same individual. Escherichia coli (normally in GI) = causes a UTI if introduced into the urinary tract. 10 5  10/08/2024 Colonization VS Infection Laboratory analysis of clinical specimens alone is not enough to differentiate colonization from infection. Clinical condition of the patient or client must also be considered. Clinical infection presents as: Symptoms of pain, fever, purulent discharge, inflammation. Significant levels of bacteria from laboratory analysis (sputum or wound swab). Other investigations that supports diagnosis of infection (CXR and CBC). 11 Infectious Disease: State in which the infected host displays a decline in wellness due to the infection. May or may not be communicable (contagious). 12 6  10/08/2024 Colonization x Infection x Infectious Disease Microbiology Laboratory Reports Primary source of information about most bacterial infections. 3 components: Smear and stain Culture- organism identification Sensitivity- antimicrobial susceptibility 13 Endogenous infections Normal flora is transmitted to sites outside their natural habitat (UTI), damage to tissues (wounds), or inappropriate use of antibiotic causing overgrowth of organism (C. difficile). Transmission Exogenous or cross-infection of Infection Transmission of microorganism from a patient or member of staff. Ex. Direct contact between patients, fomite transmission. Endemic or Epidemic Exogenous Environmental Infections Transmissions of microorganisms from the healthcare environment. Ex. Mycobacterium Sp., Pseudomonas Sp. 14 7  10/08/2024 4 Stages of Infection INCUBATION PERIOD Is the time interval between Silent stage (no symptoms) infectious agent’s entry in the Transmission and replication host and the onset of symptoms. PRODROMAL STAGE Is the time interval from the onset Vague complaint (mild and of nonspecific symptoms until generalized symptoms) specific symptoms begin to E.g. low-grade fever, body manifest weakness, fatigue ILLNESS STAGE Is the time the client is Clinical stage manifesting specific symptoms of an infectious process. CONVALESCENT STAGE The period of time from when Healing stage acute symptoms begin to disappear until the client returns to previous state of health 15 Terminologies: Pandemic Epidemic Endemic Sporadic Exceptionally Outbreak of Disease or Diseases widespread disease or a conditions occurring epidemic; sudden increase constantly irregularly, alone, disease outbreak in number of present among a without linkage with very high cases that population at all to other events proportions; spreads quickly times. global affecting many in a population. 16 8  10/08/2024 Nurses’ Role: Important to understand infectious causes and the treatment of contagious, serious, and common infections. Important role in infection control and prevention. Educating patients to decrease their risk of becoming infected or may decrease the sequelae of infection. 17 Levels of Prevention Primary prevention Promote health Improvement of socio- Prevent exposure economic status Prevent disease education and training licensing laws immunizations breastfeeding Secondary Stop or slow the progression breast cancer exam(prevention prevention of disease to prevent or of the invasive stage of the limit permanent damage, disease) through the early detection trachoma test(prevention and treatment of disease of blindness) Syphilis test (prevention of tertiary or congenital syphilis) Tertiary prevention Limit the impact of that Rehabilitation damage after the disease has Avoidance of stigma set in. Provision of disability pensions 18 9  10/08/2024 Factors Influencing Infectious Disease Host Intrinsic (born with it) factors Extrinsic (environment) factors Agent Virulence- degree to which the organism can infect the host. Environment Coexisting chronic diseases (comorbidities) Overcrowded living environment Travel to places with endemic diseases Vectors Water supply Climate 19 The Body’s Defense Against Infection A. Skin 1. Mechanical Barriers intact skin and mucous membranes. 2. Chemical barriers secretions such as tears, saliva, sweat and mucus. 20 10  10/08/2024 3. Protective & Defensive Mechanisms 21 Protective Defensive Mechanisms Fever Nutrition Antigens Antibodies 22 11  10/08/2024 Protective Defensive Mechanisms Bone marrow Leukocytosis Phagocytosis Macrophages Liver cells 23 The Body’s Defense Against Infection B. Normal Flora Normal microorganism that coexist with the body and control the growth of harmful pathogens. 24 12  10/08/2024 The Body’s Defense Against Infection C. The Inflammatory Process INFLAMMATION: Immediate and localized protective response of the body to any kind of injury or damage to its cells or tissue. 2nd line of defense to infection. 3 basic purpose: a. Neutralize and destroy harmful agent. b. Limit spread to other tissues in the body. c. Prepare damage tissues for repair. 25 C1. Inflammatory changes Blood Cells of the vessels in The blood The damaged and near cells, macrophages tissues and the site of Immune Hormonal particularly and adjacent injury, system system the phagocyte connective activates leukocytes activity tissues the clotting mechanism 26 13  10/08/2024 C2. Signs and symptoms of Inflammation Local Reactions Systemic reactions Redness Headache Heat Myalgia Swelling Fever Pain Diaphoresis Limitation and Loss Chills of function Anorexia Malaise 27 C3. Chemical Release and Vascular Changes Complement system is a group of proteins that lie dormant in the body until they have been activated through an encounter with a foreign substance. It enhances phagocytosis and inflammatory process. Example: C-reactive Protein (CRP) 28 14  10/08/2024 D. The Immune Response The Body’s Defense 3rd line of defense. Against Infection Attempts to defend and protect the body through a series of complex chemical and mechanical activities. Activities: a. Detection of entry by foreign agents as soon as they gain access to the body’s cells. b. Immediate recognition of the agents as foreign. c. Ability to distinguish one kind of foreign agent from another and to “remember” that particular agent if it appears again. Hormonal response (glucocorticoids) 29 The Infectious Process 30 15  10/08/2024 The Chains of Infection: Complete chain of events necessary for infection to occur. Nurses must clearly understand the elements of the chain of infection in order to: Identify points at which they can intervene to interrupt the chain, thus protecting patients, themselves, and others from infectious disease. 31 1. Causative Organism (Infectious Agent) An Organism that causes disease. The ability of these agents to infect is related to: Virulence of the agent Number of microorganisms present Ability of the agent to enter and in live in the client Susceptibility of the client. 32 16  10/08/2024 Pathogenicity Vs. Virulence Non- pathogenic Pathogenic Virulence 33 2. Reservoir The place where an infectious agent lives and grows. Can be living or non- living. 34 17  10/08/2024 Human Reservoirs Carrier or colonized Person colonized or carries the actual the actual infection but does not show any obvious signs and symptoms. Because they do not feel ill, they typically do not take precautions. Infectious (symptomatic) Person who has obvious signs and symptoms of infection. They are less likely to spread infection because precautions are usually taken. 35 3. Portal of Exit Any body opening that allows the infectious agent to leave. Organisms exit through: Respiratory tract Gastrointestinal tract Genitourinary tract Blood. 36 18  10/08/2024 4. Mode of Transmission How the infectious agent travels from the infected person to another person. Principles routes of transmission: Direct contact Indirect contact 37 Direct Transmission Indirect Transmission Involves immediate or direct transfer of Pathogens are transferred or carried by pathogens or agent to a susceptible some intermediate item, means, or host. process to a susceptible host. Example: Example: Direct contact Vehicle-borne (fomites) Droplet infection (within 3 feet) Vector-borne (animal) Contact with soil Airborne Inoculation into the skin Unclean hands and fingers Trans-placental 38 19  10/08/2024 Mode of Transmission Specific organisms require specific routes of transmission for infection to occur. (Some may be transmitted by more than one route.) TB- airborne Staph. aures- contact When appropriate, the nurse should explain routes of disease transmission to patients.(Weakest Link in the Chains of infection) 39 5. Portal of Entry Any body opening that allows the infectious agent to enter. Specific organisms may require specific portals of entry for infection to occur. 40 20  10/08/2024 6. Susceptible Host A non-infected person who could get infected. For infection to occur, the host must be susceptible (not possessing immunity to a particular pathogen). Previous infection or vaccine administration may render the host immune (not susceptible) to further infection with an agent. 41 Susceptible Host Factors that influence the acquisition and severity of the infection: Virulence of the infectious agent. Host factors (extreme of age, underlying disease, treatment of complex diseases, immunosuppression) 42 21  10/08/2024 43 44 22  10/08/2024 World Health Organization (WHO) and Center for Disease Control and Prevention (CDC) Principal agencies involved in setting guidelines about infection prevention. In recent years, focused more attention on Health Care- Associated infections (HAIs). 45 Preventing and Controlling the Spread of Infection: Hand Hygiene Primary intervention any health provider can use to control the spread of infection. Can be performed with soap and water or alcohol-based hand sanitizers. Take note! Hand hygiene must be performed regardless of whether gloves were used or not. 46 23  10/08/2024 Precaution Isolation Precautions Categories for Guidelines created to Infection Prevention prevent transmission of and Control in the microorganisms in the hospital. Hospital 2 tiers: Standard precaution Transmission-based precaution 47 A. Standard Precaution Primary strategy for preventing HAIs. Precautions taken against exposure to blood and/or bodily fluids. Principle: “All blood, body fluids, secretions, excretions (except sweat), non-intact skin, and mucous membranes may contain transmissible infectious agents.” Applies to ALL patients at ALL times regardless of the diagnosis. 48 24  10/08/2024 Elements of standard precaution Hand hygiene Use of PPE Proper handling of patient care equipment and linen Environmental control Prevention of injury from sharps devices (needlestick injury) Patients’ room assignments within health care facilities 49 A1. Patient Placement All patients known or suspected of Empiric Precautions having infectious disease= single room. Patients with same infectious Cohort Isolation condition= same room, if single room is not feasible. In hospitals with a consistent large Designated ward-specific number of patients with the same Precautions infectious condition= allocated specific ward. 50 25  10/08/2024 Patient movement and Precautions that need to be utilized will depend on the mode of transmission of transfer the infectious agent. Patient movement must be limited to essential purposes only. ALL departments and wards involved in the movement of the patient must be informed of the patient’s condition prior to transfer. PPEs must be worn by the healthcare worker and sometimes the patient. Decontamination of the environment and medical equipment must be carried out after the procedure. 51 A2. Hand Hygiene Recognized internationally as the most important element/intervention in the prevention of infection. A cornerstone of patient safety. Should be a quality standard in all healthcare institution. 52 26  10/08/2024 Hand Hygiene Social Hand Hygiene Antiseptic Hand Hygiene Surgical Hand Antisepsis Vigorous handwashing Handwashing with Use of antiseptic with ordinary soap and antiseptic handwash or handrub water for at least 15 agents/detergents and performed seconds then drying water. preoperatively to with with disposable Aim: remove all transient eliminate transient and paper towel. organisms and achieve reduce normal skin Visibly clean hands= higher level of flora. alcohol-based hand cleanliness than social rubs. hand-hygiene. 53 Hand Washing Guidelines: When hands are In areas with known Exposure to spore- visibly dirty or virulent or resistant When hands are not forming pathogens contaminated with organisms are likely visibly soiled: (C. difficile biological to be present: outbreaks) materials: Use alcohol-based, Use Use Gloves and Hand wash waterless antimicrobial perform hand with soap and antiseptic agents agents (e.g., washing with water. for routine Chlorhexidine antimicrobial decontamination. gluconate) soap and water. 54 27  10/08/2024 A No-No! Nurses should not wear artificial fingernails or nail extenders. Natural nails should be kept less than 0.6 cm (0.25 inch) long. Nail polish should be removed when chipped because it can support increased bacterial growth. Remove any rings or other forms of jewelry before handwashing. 55 A3. Personal Protective Equipment (PPE) PPE includes the use of barriers such as: Gloves Gowns Eye protection (googles) Respiratory protection (masks) Items of PPE can be used alone or in combination to protect the wearer from potential risk of transmissible infection. Choice of PPE is dependent on the task to be undertaken and the risk of associated with it. 56 28  10/08/2024 Gloves Anticipating direct contact with blood or body fluids, mucous membranes, non-intact skin and other potentially infectious material. Having direct contact with patients who are colonized or infected with with pathogens that can be transmitted visa contact route. Handling contaminated patient care equipment or environment. Indicated prior to surgical procedure. 57 Gowns and Aprons Anticipating direct contact with blood or body fluids, mucous membranes, non-intact skin and other potentially infectious material. Having direct contact with patients who are colonized or infected with with pathogens that can be transmitted via contact route. During a sterile procedure. 58 29  10/08/2024 Face masks Surgical masks Placed on healthcare personnel- to protect them from contact with infectious material from patient. Placed on coughing patient- to limit potential dissemination of infectious respiratory secretions. Respirators Designed to prevent and reduce the risk of transmission of airborne pathogens from an infected patient to others. Fit-testing should be done to ensure correct use of equipment. Ex. N95 masks/FFP2 or FFP3 59 Goggles and Face Shields The choice of eye protection to be worn depends on the risk to the healthcare worker. Personal glasses are not considered to be sufficient protection against blood and body fluid exposure, and specifically designed goggles or faces shields must be worn. Goggles cover the eye area alone, while face shields that extend from chin to crown ensure greater protection. 60 30  10/08/2024 Donning and Doffing of PPE 61 Safe Work Practices 1 2 3 4 Keep hands Limit surface Change gown Perform hand away form face. touched and gloves when hygiene. torn or heavily contaminated. 62 31  10/08/2024 PPE Guidelines Change gloves between contact with one body part and another. e.g., Respiratory and urinary Discard used gloves in the appropriate waste container. Do not wash or reuse. Perform hand hygiene immediately after removing gloves. 63 PPE Guidelines If you have skin lesions or weeping dermatitis, do not give direct patient care or handle equipment until condition has resolved. Prevent possible self-contamination during CPR. Use disposable barrier device for emergency breathing. Wear the appropriate PPE whenever possible. 64 32  10/08/2024 A4. Decontamination of the Environment The environment should be cleaned with a neutral detergent and water except in circumstances that require additional disinfection (e.g., blood and body fluid spillages) or contamination of specific organism that require patient to be isolated. Frequency of cleaning depends on the patient’s level of hygiene and degree of contamination. Disinfection should be carried out when required e.g., Hypochlorite (chlorine) using a product that has microbial activity against 1:10 dilution the infectious agent following the manufacturer’s instruction. 65 Management of Blood and Body Fluid Spillage Before spillage Blood spillage Body fluid management After all spillage management Place spillage Cover spillage with Do not use chlorine- Place all waste into signage. disinfectant. based disinfectants a clinical waste Don PPE. Leave for the directly on acidic trash. Use standardize recommended time solution Remove PPE. spillage kits. (2-5 min). (urine/vomitus). Perform hand Ensure spillage is Remove spillage with Remove spillage using hygiene. dealt promptly. paper towels and paper towels and Ensure the area is place on clinical place on clinical washed with waste bags. waste bags. detergent and water Wipe area with Wipe area with to remove all traces disinfectant solution. disinfectant solution. of the disinfectant. Ensure that all traces Ensure that all traces of blood are removed. of fluid are removed. 66 33  10/08/2024 A5. Disinfection of Equipment: Non-critical equipment (Low-Risk) Equipment not in contact with the patient or with intact skin. Use neutral detergent and water. Must be dried thoroughly after cleaning. 67 A5. Disinfection of Equipment: Semi-critical /critical (Intermediate/High risk) Reusable invasive medical devices (surgical instruments) and endoscopes require decontamination and sterilization. These should be handled and stored in a manner that prevents damage in the outer packaging. Sterile packages must be used prior to the expiry date detailed in the packaging. 68 34  10/08/2024 A6. Healthcare waste management: Black Dry noninfectious waste. Green Wet noninfectious waste. Yellow Infectious waste. Puncture proof containers Sharps 69 A7. Needlestick Prevention Be cautious and attentive any time you are handling a needle or sharp instrument. Do not recap used needles. Instead, place it directly into puncture- resistant containers at the point of use. Use one-handed scoop technique or deploy safety device attached to the needle. Sharps containers must be locked when two-thirds full prevent overfilling. Do not push the needles into a container that is full. OSHA requires use of needleless devices and other instruments designed to prevent injury from sharps when appropriate. 70 35  10/08/2024 Transmission- based Precaution: 71 B. Transmission-based Precaution Second tier precaution. Addition to standard precaution when organisms have been identified. 3 categories: Airborne Precautions Droplet Precautions Contact Precautions 72 36  10/08/2024 B1. Airborne Precaution Pathogens that can be transmitted through airflow that are 5 micrometers or smaller in size and remains in the environment for long periods of time. Examples: Active Pulmonary Tuberculosis Varicella (chicken pox) Rubeola (measles) 73 Airborne Precaution Guidelines Isolation room with negative pressure (minimum 6 air exchanges), rapid turnover of air and air either highly filtered or exhausted directly outside. Healthcare workers must always wear N95 respirators. Room doors should remain close at all times. Nurse should validate negative air pressure of the room. 74 37  10/08/2024 B2. Droplet Precaution Used to prevent the transmission of infectious agents spread through close respiratory or mucous membrane contact with respiratory droplet (>5 microns through sneezing, coughing etc.) Examples: Mumps Meningitis Pertussis Influenza 75 Droplet Precaution Guidelines Wear surgical face mask Stand 3-6 feet away form the patient. Room doors may be opened. May cohort patient. 76 38  10/08/2024 B3. Contact Precaution Used for organisms that are spread by skin-to-skin contact (direct contact) or contact with environment (indirect contact). Example: C. Difficile infections Multidrug-resistant organisms (MRSA) Scabies Herpes simplex virus Zoster 77 Contact Precaution Guidelines Hand hygiene Gloves and gown are a must. Preferably private room. Masks are not needed. Doors do not need to be closed. 78 39  10/08/2024 Transmission Private room Masks Gowns Gloves -based Precaution Airborne Always Must wear fit-tested No No Precaution Door to room must N95 respirators Unless draining Unless draining be closed at all wounds. wounds. times. Droplet Preferred Surgical mask when Not usually. When helping with Precaution Cohorting of same entering patient cough-inducing type of infection is room. procedures or acceptable. Patient should wear discarding used a mask during tissues. transport. Contact Preferred Situation dependent. Always Always Precaution Cohorting of same If patient is cohorted, If patient is cohorted, type of infection is staff must perform staff must perform acceptable. hand hygiene and hand hygiene and change of PPE change of PPE between patients. between patients. 79 Remember!!! When you are using PPE, you Solution: Plan ahead and obtain cannot retrieve common items necessary supplies and from your uniform pocket. (pen, equipment before entering the alcohol, stethoscope) patient’s room. 80 40  10/08/2024 Isolation signages 81 Protective Environment (Reverse Isolation) Expanded isolation technique used for immunocompromised condition. Stem cell transplantation Conditions that severely suppress immune system (HIV/AIDs; Cancer) Interventions Special airflow and filtration rooms (+ air pressure, smooth surfaces). Staff must be free from signs and symptoms of illness. Sterile PPE when caring for patient. Limit visitors (