INFECTIONS

NCM 104 – Class 2015

Review of Physiology• Resistance

A. Non-specific Resistance- Body surface barriers- Anti Microbial Secretions- Internal Anti Microbial agents- Phagocytosis part of the reticoendothelial

systema. phagocytes- Microphages- Macrophages

• B. Specific Resistance- lymphatic system

- lymph vessels- lymph nodes- lymph

- spleen

Specific Resistance (cont)

• Antigen A. B-lymphocytesB. T – LymphocytesC. Memory Cells

• Antibody1. IgG2. IgA3. IgM4. IgD5. IgE

• Antigen – antibody reactionsa. Agglutinationb. Cytolysisc. Opsonizationd. Neutralization (viral)e. Neutralization (toxin)f. Precipitation

Chain of Infection

Susceptible host Portal of Entry Etiologic Agent (microorganism)ReservoirMethod of transmission from reservoir to

(Source) susceptible host Portal of exit

Pathogens• Bacteria

– Aerobic – Anaerobic

• Viruses - intracellular parasite capable of reproducing outside of a living cell.

• Mycoplasma – similar to bacteria and have no cell wall – resistant to antibiotics that inhibit cell wall synthesis

• Rickettsiae & Chlamydia- rigid cell wall; with some feature of both bacteria and viruses. – Chlamydia- transmitted by direct contact – Rickettsiae- infect cells of arthropods and are transmitted by these vectors.

• Fungi- self-limited, affecting the skin and subcutaneous tissue.

• Parasites

Reservoir

-where the pathogen lives and multiplies – Endogenous – Exogenous

• Mode of Transmission – Direct contact – Indirect contact

• Vector – Droplet or airborne transmission

Host Factors • Factors that enable a host to resist infections:

• Physical barriers • Hostile environment created by stomach acid secretions, urine & vaginal secretions. • Antimicrobial factors e.g. saliva, tears • Respiratory defenses • Specific and nonspecific immune responses to pathogenic invasion. • Age • Nutrition

Portal of Entry

• Respiratory Tract • GI Tract • Genitourinary Tract • Skin and mucous membrane • Bloodstream

Stages of Infectious Process • Incubation period – period begins with active replication but with no symptoms • Prodromal stage – Symptoms first appear • Acute phase – proliferation and dissemination of pathogens • Convalescent stage- containment of infection and pathogens are eliminated • Resolution – total elimination of pathogens without residual manifestation

Nosocomial infection – Infection acquired in a health care setting. – Typically manifest after 48 hrs. – UTI most common type

FACTORS AFFECTING RISK OF INFECTION

• AGE• HEREDITY• LEVEL OF STRESS• NUTRITIONAL STATUS• CURRENT MEDICAL THERAPY• PRE-EXISTING DISEASE• IMMUNIZATION STATUS

Standard precautions • Blood • All body fluids, secretions, excretions, • Non-intact skin • Mucous membranes

• Essential elements: • Use barrier protection • Prevent inadvertent percutaneous exposure, dispose of needles • Immediate and thorough hand washing

Infection Control and Prevention

Infection Control in In-Patient Health Care Agencies

• Hand Hygiene• Patient Placement• Protective Equipment• Proper disposal of Soiled Equipment

Infection Control In Community – Based Setting

• Sanitation• Proper Disposal of Waste• Food Preparation• Report CD Occurrence

Pharmacology

• Check for: – History of hypersensitivity. – Age and childbearing status of the

client. – Renal function – Hepatic function

– Site of infection • Classification of antimicrobial preparations:

– Bacteriostatic – Bactericidal

COMMUNICABLE DISEASE

– Is any disease that can be transmitted directly or indirectly from one person to another

INFECTION

– Is a condition caused by the entry and multiplication of pathogenic microorganisms within the host body.

– It is also an invasion of an organisms (bacteria, helminths, fungi, parasite, ricketsia and prion)

ISOLATION

– It is necessary when a person is known or suspected to be infected with pathogens that can be transmitted by direct or indirect contact.

– The principle behind isolation technique is to create a physical barrier that prevents the transfer of infectious agents. To do this you have to know how the organisms are transmitted.

Transmission-Based Precautions

–Airborne–Droplets–Contact

AIRBORNE

– PRIVATE ROOM– NEGATIVE AIR PRESSURE– VENTILATION SAFEGUARDS air from room is not

recirculated to other areas– DOOR SHOULD BE KEPT CLOSED– BARRIER TO SMALL PARTICLES masks HEPA high

efficiency particulate air– COVER MOUTH OF PATIENT WITH MASK DURING

TRANSPORT

DROPLET

• – PRIVATE ROOM– WEAR MASK IF WORKING WITHIN 3 FEET– WEAR MASKS UPON ENTRY INTO THE ROOM– COVER MOUTH OF PATIENT WITH MASK DURING

TRANSPORT

CONTACT– PRIVATE ROOM– WEAR GLOVES– GLOVES ARE REMOVED BEFORE EXITING FROM

THE ROOM– HANDS ARE WASHED THOROUGHLY– NOTHING IS TOUCHED BEFORE EXITING THE

ROOM– GOWN IS WORN WHEN ENTERING THE ROOM– REMOVE GOWN CAUTIOUSLY BEFORE LEAVING

THE ROOM– PATIENT CARE ITEMS SHOULD BE RESTRICTED TO

SINGLE PATIENT

AFB ISOLATION

– VISITORS REPORT TO NURSES’ STATION BEFORE ENTERING ROOM• MASKS ARE TO BE WORN IN THE PATIENT’S ROOM• GOWNS ARE INDICATED TO PREVENT CLOTHING

CONTAMINATION• GLOVES ARE INDICATED FOR BODY FLUIDS AND NON-

INTACTSKIN• HANDWASHING-after touching the patient or

potentially contaminated articles and after removing gloves• articles should be discarded, cleaned or sent for

decontamination and reprocessing• room is to remain closed• patient is to wear mask during transport

STRICT ISOLATION– VISITORS-REPORT TO NURSES’ STATION BEFORE

ENTERING ROOM– PRIVATE ROOM-necessary, door must be kept closed– GOWNS-must be worn by all persons entering the room– MASKS- must be worn by all persons entering the room– HANDS-must be washed on entering and leaving room– GLOVES-must be worn by all persons entering the room– ARTICLES-must be discarded, or wrapped before being

sent to CENTRAL SUPPLY for disinfection or sterilization

RESPIRATORY ISOLATION

– VISITORS-REPORT TO NURSES’ STATION BEFORE ENTERING ROOM

– PRIVATE ROOM-necessary, door must be kept closed– GOWNS-gowns not necessary– MASKS- must be worn by all persons entering the room

if susceptible disease– HANDS-must be washed on entering and leaving room– GLOVES-not necessary– ARTICLES-those contaminated with secretions must be

disinfected– CAUTION-all persons susceptible to the specific disease

should be excluded from the area, susceptibles must wear masks

WOUND AND SKIN PRECAUTIONS

– VISITORS-REPORT TO NURSES’ STATION BEFORE ENTERING ROOM

– PRIVATE ROOM-desirable– GOWNS-must be worn by all persons having direct

contact with the patient– MASKS- during dressing changes– HANDS-must be washed on entering and leaving

room– GLOVES-must be worn by all persons having direct

contact with infected area– ARTICLES-instruments, dressing, linens

ENTERIC PRECAUTIONS

– VISITORS-REPORT TO NURSES’ STATION BEFORE ENTERING ROOM

– PRIVATE ROOM-necessary FOR CHILDREN ONLY– GOWNS- must be worn by all persons having direct

contact with the patient– MASKS- not necessary– HANDS-must be washed on entering and leaving room– GLOVES-must be worn by all persons having direct

contact with patient or articles contaminated with fecal material

– ARTICLES-special precautions necessary for articles contaminated with urine and feces, must be disinfected or discarded

PROTECTIVE ISOLATION

– VISITORS-REPORT TO NURSES’ STATION BEFORE ENTERING ROOM

– PRIVATE ROOM-necessary, door must be kept closed

– GOWNS- must be worn by all persons entering room

– MASKS- - must be worn by all persons entering room

– HANDS-must be washed on entering and leaving room

– GLOVES-must be worn by all persons having direct contact with patient