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Infection
P & P Chapter 34
Susan Fowler
[email protected]
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Objectives (pp.4-6)
• We will be combining the objectives from the
Infection and Inflammation Concepts.
• The Infection Concept is presented in this
lecture. MRSA, Cellulitis, and UTI are the
exemplars for the Infection Concept and are
in a separate lecture.
• The Inflammation Concept and its exemplar,
appendicitis, is a separate lecture.
• Please look in the Infection Control folder for
additional useful information.
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Nature of Infection
• Infection—disease state resulting
from the presence of pathogens in
the body. May be acute or chronic
• Pathogens—disease-producing
microorganisms—bacteria, viruses,
fungi, parasites (643). The presence
of these pathogens usually produces
an inflammatory response.
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Course of Infection (646)
• Incubation period—time between entry of
pathogen and onset of sx
• Prodromal stage—nonspecific sx, most
infectious
• Illness stage—worst sx
• Convalescence—recovery time
• Length of each stage depends on type of
infection—may be local or systemic
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Chain or Cycle of Infection (642)
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Infectious agent (pathogen)
Reservoir (place it lives)
Portal of exit (orifices or breaks)
Mode of transmission (how it moves)
Portal of entry (orifices or breaks)
Susceptible host (stressors)
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Infectious Agent (Pathogen)
• Depends on warmth, darkness, food,
water, moisture, presence or absence of
O2, proper pH. Some can produce spores
when conditions are not favorable. Some
mutate in order to survive.
• Number and ability to reproduce
• Virulence—hardiness and invasiveness
• Entry and survival in host—have specificity
• Susceptibility of host
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Reservoir
• Human—mucous membranes of
tracts, tissues, blood
• Animal—same
• Water
• Soil
• Air
• Fomites
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Modes of Transmission (645)
• Contact:
– Direct—person to person
– Indirect—person to object
– Droplet—traveling particles
• Air: coughing, sneezing, dirt particles
• Vehicles: water, blood, food, items
• Vectors: flies, ticks, mosquitos, fleas, lice
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Defenses Against Infection
• Normal body flora
• Body system defenses—647
• Inflammatory response
– Vascular and cellular responses
– Formation of exudates
– Tissue repair
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The Susceptible Host
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Changes in normal body flora
Breakdown in body systems
Flawed inflammatory response
Problems with tissue repair
Stressors
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Nosocomial Infections (HAIs)
• Latin for “hospital acquired” Now called
“health care associated infections”
• Approx 2 million/yr; $4.5 million; 11th
leading cause of death in U.S.
• Top infections—648
• Iatrogenic—caused by procedure
• Exogenous—external or outside body
• Endogenous—internal or inside body
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How Do We Stop the Infection
Cycle? Assessment
• Status of body defenses (skin, resp,
etc)
• Client susceptibility (risk factors)
• Clinical appearance—may be
symptomatic or asymptomatic
• Lab data
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Client Susceptibility
• Age—see p. 649
• Nutritional status—those with low protein
levels; those who need more protein d/t
illness state; those who cannot feed
themselves or can’t swallow
• Stress—resistance is lower
• Diseases that impair the body defenses and
immunity
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Clinical Appearance
• Localized
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Warmth
Swelling
Redness
Drainage
Pain/tenderness
Restricted movement
• Systemic
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Changes in VS
Fatigue
N/V/D
Malaise
Lymphadenopathy
Confusion
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Laboratory Data (651)
• WBC (Totals and differentials) Amount
elevated usually indicates severity. “Left
shift” usually indicates a severe
infection.
• ESR—Non-specific inflammatory
marker
• Fe—low in chronic infection
• +Cultures and gram stains
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Pertinent Nursing Diagnoses
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Infection
Skin integrity
Incontinence
Imbalanced nutrition
Self-care deficit
Impaired oral mucous membrane
Social isolation
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Expected Outcomes—What Do
We Want Clients to Achieve?
• Client will be free of infection
• Exposure to infection will be reduced
• Client will receive care that will eliminate
existing infection
• Client/family understand S/S of infection
• Client/family understand how to reduce
risk of infection
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Interventions
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Protect clients (662)
Educate clients (669)
Maintain own worker health
Give antimicrobials
Be aware of S&S of infection
Practice medical and surgical asepsis
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Medical Asepsis
• Practices designed to reduce the # & transfer
of pathogens. A.K.A. “clean technique”
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Handwashing
Cleaning and disinfecting surfaces
Applying clean dressings
Applying Standard Precautions (663)
Observing transmission-based precautions (663)
Utilizing isolation procedures
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Surgical Asepsis
• Practices designed to render & keep
objects & areas free from microorganisms.
A.K.A. “sterile technique.” Principles p. 669
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Sterile procedures
Opening and maintaining a sterile field
Sterile scrub
Surgical skin prep
Gowning/gloving
Sterilization of surfaces
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Evaluating Outcomes
• How do you know client is free from
infection?
• How do you know exposure has been
reduced?
• How do you know if client received
treatment?
• How do you know if client/family
understand?
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Who is Responsible for
Controlling Infection?
• Center for Disease Control (CDC)
• Occupational Health and Safety
Organization (OSHA)
• Joint Commission on Accreditation of
Healthcare Organizations (JCAHO)
• Infection Control Professional
• Anyone who comes in contact with
patients!
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Noteworthy Precautions
• Although it is allowed by CDC and JCAHO,
keep in mind that the following require extra
care to prevent the spread of pathogens:
– Medical and surgical patients not being separated
– Peds patients with adult patients
– Patients with drains in same room as infectious
patients
– Lack of private baths
– Nurses caring for both infectious and
noninfectious patients
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