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Transcript
Infection P & P Chapter 34 Susan Fowler [email protected] Mosby items and derived items © 2005 by Mosby, Inc. 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. Mosby items and derived items © 2005 by Mosby, Inc. 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. Mosby items and derived items © 2005 by Mosby, Inc. 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 Mosby items and derived items © 2005 by Mosby, Inc. Chain or Cycle of Infection (642) • • • • • • 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) Mosby items and derived items © 2005 by Mosby, Inc. 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 Mosby items and derived items © 2005 by Mosby, Inc. Reservoir • Human—mucous membranes of tracts, tissues, blood • Animal—same • Water • Soil • Air • Fomites Mosby items and derived items © 2005 by Mosby, Inc. 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 Mosby items and derived items © 2005 by Mosby, Inc. Defenses Against Infection • Normal body flora • Body system defenses—647 • Inflammatory response – Vascular and cellular responses – Formation of exudates – Tissue repair Mosby items and derived items © 2005 by Mosby, Inc. The Susceptible Host • • • • • Changes in normal body flora Breakdown in body systems Flawed inflammatory response Problems with tissue repair Stressors Mosby items and derived items © 2005 by Mosby, Inc. 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 Mosby items and derived items © 2005 by Mosby, Inc. 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 Mosby items and derived items © 2005 by Mosby, Inc. 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 Mosby items and derived items © 2005 by Mosby, Inc. Clinical Appearance • Localized – – – – – – Warmth Swelling Redness Drainage Pain/tenderness Restricted movement • Systemic – – – – – – Changes in VS Fatigue N/V/D Malaise Lymphadenopathy Confusion Mosby items and derived items © 2005 by Mosby, Inc. 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 Mosby items and derived items © 2005 by Mosby, Inc. Pertinent Nursing Diagnoses • • • • • • • Infection Skin integrity Incontinence Imbalanced nutrition Self-care deficit Impaired oral mucous membrane Social isolation Mosby items and derived items © 2005 by Mosby, Inc. 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 Mosby items and derived items © 2005 by Mosby, Inc. Interventions • • • • • • Protect clients (662) Educate clients (669) Maintain own worker health Give antimicrobials Be aware of S&S of infection Practice medical and surgical asepsis Mosby items and derived items © 2005 by Mosby, Inc. Medical Asepsis • Practices designed to reduce the # & transfer of pathogens. A.K.A. “clean technique” – – – – – – Handwashing Cleaning and disinfecting surfaces Applying clean dressings Applying Standard Precautions (663) Observing transmission-based precautions (663) Utilizing isolation procedures Mosby items and derived items © 2005 by Mosby, Inc. Surgical Asepsis • Practices designed to render & keep objects & areas free from microorganisms. A.K.A. “sterile technique.” Principles p. 669 – – – – – – Sterile procedures Opening and maintaining a sterile field Sterile scrub Surgical skin prep Gowning/gloving Sterilization of surfaces Mosby items and derived items © 2005 by Mosby, Inc. 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? Mosby items and derived items © 2005 by Mosby, Inc. 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! Mosby items and derived items © 2005 by Mosby, Inc. 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 Mosby items and derived items © 2005 by Mosby, Inc.