Post on 06-Jan-2018
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MSALI: INFECTIONS
Terms■Pathogens■Host■Colonization■Reservoir■Causative Agents■Bacteria ■Aerobic■Anaerobic■Mode of Transmission■Portal of Entry
■Portal of Exit■Fungi■Virus■Protozoa■Helminths■Prions■Human Body’s Defense
Mechanisms■Sepsis
Infection Control in Health-Care Agencies
■Community-acquired Infection■Nosocomial Infection or
Hospital – Acquired (HAI)■Hand Hygiene
Nosocomial Infections■Medicare implemented a policy on October 1, 2008
that penalizes hospitals if Medicare patients acquire any of 8 conditions during their inpatient stay
■3 of these conditions are infections:■ Catheter-Associated Urinary Tract Infection (UTI)■ Vascular Catheter-Associated Infection■ Surgical Site Infections, various
Nosocomial Infections
■Infection from Stay in Health-care Agency
■Risk Factors– Host’s Condition– Multiple Antibiotic Therapy – High-risk Units
Nosocomial Infections (cont’d)
■Common Pathogens– Escherichia coli (E. coli) – Staphylococcus aureus – Pseudomonas aeruginosa
Hand Hygiene
■Before and After– Patient
Contact– Glove Use
Local vs. Systemic Infections
■Local
■Pain, redness, swelling, warmth at site
■ Systemic
■ Headache, malaise, fever, anorexia, aches.
■ Can progress to hypotension, tachycardia, mental confusion
Gram Positive Bacteria
Medications to Treat Infectious Diseases■Table 8.3
■Nursing responsibilities:■Note all patient allergies■Obtain culture samples before initiating
antibiotic treatment■Monitor and report all side effects■Observe for s/s of superinfections
Antibiotic Resistant Infections
Who Is At Risk?■Severe and/or prolonged illness■Persons with comorbidities – especially chronic
renal disease, diabetes mellitus, peripheral vascular disease, skin lesions
■Previous exposure to antimicrobial agents■Invasive procedures – such as dialysis,
invasive devices, urinary cauterization, surgery
■Repeated contact with HC system■Previous colonization of MDRO■Advanced Age
MRSA■Methicillin Resistant staphylococcus
aureus■- a bacteria
■Common sites :– Nares– Skin
Colonized
Treatment■I & D■Contact ISO Precautions
■Clindamycin■Tetracyclines■Rifampin■Linezolid■Bactrim■Mupirocin ointment for topical tx
Prevention
■Hand Hygiene
■Decolonization
Decolonization
■Mupirocin ointment for nares
■Use of daily chlorhexidine baths in ICU ■populations may decrease overall rates of ■bloodstream infections and MRSA ■acquisition, but effect on MRSA infections ■less clear
VRE
■Vancomycin-resistant Enterococci
■- a bacteria
■normally present in the human intestines and in the female genital tract and are often found in the environment.
What types of infections does VRE cause?
■It can cause infections of the urinary tract, the bloodstream, or of wounds associated with catheters or surgical procedures.
Who is at RISK?■People who have been previously treated
with the antibiotic vancomycin or other antibiotics for long periods of time.
■People who are hospitalized, particularly when they receive antibiotic treatment for long periods of time.
■People with weakened immune systems.■People who have undergone surgical
procedures.■People with medical devices that stay in for
some time such as urinary catheters or central intravenous (IV) catheters.
■People who are colonized with VRE.
Treatment
■People who are colonized do not usually need treatment.
■Most VRE infections can be treated successfully with antibiotics other than vancomycin.
■Laboratory testing of the VRE sample can determine which antibiotics will successfully treat the infection.
Clostridium difficile Infection
■A spore-forming, Gram-positive anaerobic bacillus
■The bacteria are found in the feces.
■Associated with ABX use.
S/S of Clostridium difficile infection?
■watery diarrhea (at least three bowel movements per day for two or more days)
■fever■loss of appetite■nausea■abdominal pain/tenderness
The risk for disease increases in patients with:
■antibiotic exposure■proton pump inhibitors■gastrointestinal surgery/manipulation■long length of stay in healthcare settings■a serious underlying illness■Immuno-compromising conditions■advanced age
Treatment
■The infection can usually be treated with an appropriate course of antibiotics,
■including metronidazole, vancomycin , or recently approved fidaxomicin.
■Fecal Transplant
■Contact Isolation - Healthcare workers and visitors must use gloves and gowns on entry to a room of a patient with CDI.
■Emphasize compliance with the practice of hand hygiene.
Community Acquired Infections
■An infection acquired outside health care settings, such as in the home or in the community.
Communicable Diseases
■See Handout
Influenza
■Influenza viruses are spread from person to person primarily through large-particle respiratory droplet
transmission (e.g., when an infected person coughs or sneezes near a
susceptible person).
■The typical incubation period for influenza is 1—4 days (average: 2 days)
■Most healthy adults may be able to infect others beginning 1 day before symptoms develop and up to 5 to 7 days after becoming sick
S/S
■fever, myalgia, headache, malaise, nonproductive cough, sore throat, and rhinitis
Occurrence
Diagnostics
■Preferred respiratory samples for influenza testing include nasopharyngeal or nasal swab, and nasal wash or aspirate, depending on which type of test is used .
■Samples should be collected within the first 4 days of illness.
■Rapid influenza diagnostic tests provide results within 20 minutes or less; viral culture provides results in 3-10 days
Prevention – FLU Vaccination – for residents and employees■Flu vaccines cause antibodies to develop in the
body about two weeks after vaccination. These antibodies provide protection against infection with the viruses that are in the vaccine.
■The seasonal flu vaccine protects against the influenza viruses that research indicates will be most common during the upcoming season.
Treatments■Three antiviral drugs recommended by the
CDC & approved by the FDA:oseltamivir (brand name Tamiflu®), zanamivir (brand name Relenza®) and peramivir (brand name Rapivab®). Tamiflu® comes as a pill or liquid, and Relenza® is an inhaled powder. (Relenza should NOT be used in anyone with breathing problems, like asthma or COPD, for example.) Rapivab® is administered intravenously.
Complications
■Dehydration■Pneumonia■Change in Mental status
Nursing Diagnoses
■Fluid Volume, deficient■Activity Intolerance■Risk for Injury■Impaired Comfort■Risk for Ineffective Breathing