COMPETENCY 2: Safety and Infection Control I. THE BODYS NORMAL DEFENSES AGAINST INFECTION A.

Normal Flora- helps keep potential harmful bacteria; help maintain health; do not cause dse(disease) B. Body System- skin, mouth, respiratory tract, urinary tract, GIT & vagina C. Inflammatory Response- protective vascular mechanism that eliminates offending agents - occurs in response to infection or injury - neutralizes & eliminates necrotic tissues & prepare for tissue repair 5 Cardinal signs of infection (classical signs Latin-based naming) Pain/tenderness- dolor (some internal organs have no sensory endings(pain) ex.in pneumonia) Redness- rubor Localized: Immobility/Loss of function- function laesa @ Specific site of injury Swelling- tumor Heat- calor Fever with ( PR, RR) Leukocytosis Malaise- general feelings of discomfort/ weakness Anorexia-loss of appetite Nausea and Vomiting- stomach flu Lymph node enlargement & tenderness

Systemic: Affects entire body often fatal

2 Inflammatory Processes i. Vascular Stage: small blood vessels constricts arterioles & veins vasodilates histamine released making it permeable to protein-rich fluid redness&heat ii. Cellular Stage: WBC (neutrophil-engulfing m.o) to site D. Immune Response- when antigen enters body; body commonly responds to the antigen by producing antibodies. i. Humoral immunity- antigen-antibody reaction ii. Cellular/ adaptive immunity- WBC; against malignant cells, bacterial, viral&fungal infection

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CHAIN OF INFECTION & TRANSMISSION

Infectious agent Host suscepti bility reservoir

Process resulting in an infection (chain) Infection occurs if chain remains intact To prevent infection=break the chain

Portal of entry Transmi ssion

Portal of exit

a. Infectious agent- depends on number of m.o (fungi,bacteria, virus) present, virulence (ability to produce dse), ability to enter& survive in the host, & susceptibility of host b. Reservoir- place of multiplication& survival of m.o 1) Human: Acute : symptomatic Carriers: asymptomatic, can transmit dse Ex. Person with HIV- may not exhibit s/sx bec it may not occur for yrs. HIV can transmitted by sexual contact, sharing needles/syringe; Mother can transmit virus to her child during pregnancy, birth, or breastfeeding. 2) Animals 3) Insects 4) Food, water, feces, fomites

c.

Portal of exit- points of escape from the reservoir

(skin, mucuos membranes, respi-tract, GIT, urinary tract, reproductive tract, blood, open wounds) d. Transmission: direct/indirect route Contact Direct- person-to-person, physical (touching, kissing, sexual intercourse) Indirect- m.o transmitted from contaminated equipment/ fomites (touching contaminated dressings, bed rail, needles, bp cuff) Droplet- large particles that travel upto 3ft or 5mcm (coughing, sneezing, talking) Airborne- droplet nuclei residue or evaporated droplets suspended in air (cough, sneeze, talking) & organism Vehicles-contaminated blood, improper handling food, H2O, drugs solutions, fomites Vectors-non-human carriers: mosquitoes, ticks, lies, fleas, flies

e. Portal of entry- same as port of exit f. Host of susceptibility- degree of resistance to the pathogen
more virulent organism---more likely to develop infxn Age (very young, very old, immunocompromised) Nutritional status Presence of chronic dse Trauma Smoking

III.

INFECTION PROCESS (LOCALIZED & SYSTEMIC) Stages of Infection: a. Incubation period: organisms are growing & multiplying (Acute: short period; Chronic: long) b. Prodomal Stage: most infectious stage, early s/sx which are vague and non-specific c. Full stage of illness: specific s/sx d. Convalescent period: recovery period, disappearance of s/sx, healthy state S/SX & PHYSIOLOGICAL RESPONSES TO INFLAMMATION -vascular and cellular stages are the main components of inflammatory process and these physiological process are responsible for the appearance of the cardinal signs MAJOR COMPLICATIONS OF INFECTIONS (cant find this on the book.) PATIENTS AT RISK FOR ACQUIRING INFECTIONS Very young, very old, immunocompromised Patients with broken skin Patients with low WBC Neonates & older adults Patients with no immunizations Patients with stress level Patients with invasive or indwelling medical devices (ex.catheter) bec it provided exposure to/entry of m.o Patient with poor health or weak SITES FOR & CAUSES OF NOSOCOMIAL INFECTIONS -improper hand washing a. Urinary Tract- unsterile insertion of urinary catheter; improper positioning of drainage tubing b. Surgical or Traumatic wounds c. Respiratory Tract

IV.

V. VI.

VII.

d. Bloodstream Iatrogenic- from treatment or diagnosis procedure Exogenous- causative organism from other people (ex. Clostridium difficile) Endogenous-microorganisms transferred to another body site (Enterococci)

VIII.

NSG INTERVENTIONS TO BREAK THE CHAIN OF INFECTION A. Health promotion- prevention (key to reduce infection); review & teach patients & families measures to strengthen the hosts defenses such as: 1. Nutrition: Proper diet for proper immune functioning; eating variety of foods from all food groups Teach patients the importance of a proper diet. Cultural beliefs can critically influence food selection and method of preparation Design education programs specific to patient learning needs with collaboration of registered dietitians. 2. Hygiene: Teach patient to wash the perineum from urethra down toward the rectum Teach proper handwashing technique Teach patient on how to maintain good oral hygiene 3. Immunization: It have decreased many childhood diseases Advise patient about the advantages of immunizations Some immunizations are contraindicated to pregnant or lactating women 4. Adequate rest and regular exercise Exercise lung capacity, circulation, energy & endurance Decreases stress, increases appetite, sleeping, and elimination B. Acute Care- continue preventive care to reduce transmission (aseptic methods) Perform standard precautions or transmission-based precautions Nurses collect specimens of body fluids from infected site and send to lab testing. Administration of antibiotic (prescribe by a health care provider)

Watch for allergic reactions & assess the effect on the patients infection. Educate patient on the importance of completing antibiotic therapy upon discharge. Drinking fluids regularly prevents dehydration resulting from diaphoresis Adequate nutritional intake to metabolic rate Adequate rest for healing process Remove wound drainage using moist-to-dry dressings Apply warm compresses to blood flow of the infected site Medical and surgical asepsis in managing wounds

1. Medical asepsis- use for all patients, control or elimination of infectious agents, cleaning, disinfetion & sterilization 2. Control or elimination of reservoir- eliminate sources of body fluids, drainage, solutions 3. Control of portals of exit Avoid talking, sneezing, coughing directly over a wound/dressing Teach patient how to protect others---ex. using tissue Avoid working with patients with high susceptible infection when you have cold/other communicable infection Using standard precautions when handling body fluids Wear gloves. Hand hygiene. 4. Control of transmission Know modes of transmission of the disease Dont share patient care items Always wipe off the bell, diaphragm, ear tips of the stethoscope Do not shake linens/ bedcloth Use dust with treated/ dampened cloth Do not carry dirty linen in arms against uniform Use special linens bags. Never put linens on the floor. a) Hand hygiene- most important; hand washing, antiseptic handwashing, antiseptic hand tub, surgical hand antisepsis o If hands is visibly soiled, wash hands with soap & water o Before eating, after using restroom, exposed to spore forming organism b) Isolation & barrier protection: standard and transmission-based precautions c) Protective environment- special or isolation rooms d) PPE e) Specimen collection- label specimen infront of the patient; secure in a leak proof biohazard bag f) Bagging- biohazard waste: infectious and medical wastes are disposed in red bags g) -vascular and cellular stages are the main components of inflammatory process and these physiological process are responsible for the appearance of the cardinal signs 5. Control of portals of entry (box 13-13) 6. Protection of the susceptible host Regular bathing Lubrication to keep skin hydrated and intact Regular oral hygiene and flossing Adequate fluid intake Regular coughing and deep breathing exercise to remove mucus from lower airways C. Restorative care: 3 common infection in long term facilities; pneumonia, UTI, pressure ulcers

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STANDARD PRECAUTIONS

X.

TRANSMISSION-BASED PRECAUTIONS

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MODE TRANSMISSION OF HEPA-B, HEPA-C, HIV HBV (person-to-person): infected blood, body fluids, sharing contaminated needles, blood transfusions, hemodialysis, maternal-fetal route, unprotected sexual intercourses HCV (blood-to-blood): illicit IV drug needle sharing, organ transplants, needle-stick injury, unsanitary tattoo equipment, sharing of intranasal cocaine paraphernalia MEDICAL & SURGICAL ASEPSIS Medical Asepsis: clean technique to reduce the number of m.o & reduce their spread Example: hand hygiene, barrier techniques, routine environmental cleaning Surgical Asepsis: sterilization technique to eliminate all m.o & kept free of m.o Principles: Sterile object remains sterile only when touched by another sterile object Place only sterile object on a sterile field A sterile object/ field becomes contaminated by prolonged exposure to air Object becomes contaminated when it comes in contact with a wet contaminated surface. Hold hands above below to allow water to flow downward without contaminating hands The edges a sterile field/ container (1inch or 2.5cm) are contaminated

XII.

XIII.

Document and analyze care related information using knowledge of computer hard and software to manage patient care. (cant find this on the book) CULTURALLY COMPETENT CARE A process in which the health-care provider continually strives to work effectively with individuals, families, and communities. Acknowledge and value diversity. Ability to give care to diverse populations Openness to cultural differences Flexibility or adaptability to different situation

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