Function of nurses: Provide a biologically safe environment
Microorganisms always present in the environment exists in water, soil, and body surfaces such as skin, intestinal tract, & areas open to the outside (mouth, upper and lower urinary tract, and vagina)
Resident Flora or Bacteria microorganisms that are a common resident in one body part yet produce infection in other part (ex. E.Coli, a resident flora in intestine that causes UTI); microorganisms that normally live in the skin.
Transient Flora or Bacteria microorganism picked up by the skin as a result of normal activities and can be removed readily.
Infection invasion of body tissue by microorganism and their growth there
Infectious agent microorganisms that invade body tissue and grow there
Asymptomatic or Subclinical Infection microorganisms that produce no clinical evidence of disease but some cause damage (ex. CMV in pregnant woman can lead disease in unborn child)
Disease Detectable alteration of normal tissue function Alteration in body functions resulting in reduction of capacities and shortening of normal life span. Disturbance of the structure and function of the body or its constituent parts.
Communicable Disease results if an infectious agent can be transmitted to another by direct or indirect contact (thru vector or vehicle) or as an airborne infection
Virulence- vigor with which the organism can grow and multiply; microorganisms vary their ability to produce disease.
Pathogen Disease producing microorganism Pathogenicity ability to produce a disease Opportunistic Pathogen causes disease only in susceptible individuals True Pathogen causes disease in a healthy individual
World Health Organization (WHO) Major regulatory agency at the International Level for disease prevention and control
Centers for Disease Control and Prevention (CDC) Principle public health agency at the National Level for disease prevention and control
Asepsis Freedom from or absence of disease causing microorganisms ; free from infection. Has 2 Types: a. Medical Asepsis Clean Technique Practices that confine a specific microorganism in a specific area, limiting or reducing the no., growth, and transmission
b. Surgical Asepsis Sterile Technique Practices that keep area or object free from microorganisms Destroy ALL microorganisms and SPORES (microscopic dormant structures formed by pathogens that can survive in common cleaning technique) Used for procedures that involves sterile areas of the body Used for invasive procedures Sepsis Presence or State of Infection Septicimia transport of infection throughout the body or blood
Types of Microorganism Causing Infections 1. Bacteria most common infection causing microorganism; can live and transported thru air, water, food, soil, body tissues and fluids, and inanimate objects 2. Viruses consists of nucleic acid and therefore must enter cells to reproduce (ex. Rhinovirus most common; cause of common cold; hepatitis, herpes, HIV) 3. Fungi yeasts & molds (ex. Candida Albicans - normal flora in vagina) 4. Parasites live in other organisms (ex. Protozoa that causes Malaria; worms; anthorpods such as mites, ticks, and fleas)
Colonization - Process which microorganisms become resident flora they grow and multiply but dont cause disease.
TYPES OF INFECTION 1. Local Infection limited to specific body part where microorganisms remain. 2. Systemic Infection microorganisms spread and damage different body parts 3. Acute Infection appears sudden/abrupt and last a short time <6 months 4. Chronic Infection occurs slowly or gradually, over a long period of time and last months or years ( >6 months) 5. Bacterimia presence of bacteria in blood; bacterimia results to septicemia 6. Septicemia transport of infection throughout body or blood.
Nosocomial Infection Hospital acquired infection Hospital associated (associated with the delivery of health care services in a health care facility) Infection acquired 48 hours after admission to hospital. Develops during client stay and manifest after discharged Can originate from client themselves (endogenous source most common) or from hospital and hospital personnel (exogenous source)
Common sites Urinary (ex. unsterile indwelling urinary catheter) Respiratory GIT Bloodstream Skin, Wound, Burn Surgical Site Infection Others
Factors that can contribute to Nosocomial Infections: Iatrogenic Infection unintended infection result of diagnostic or therapeutic procedures (ex. Bacterimia from intravascular line) Compromised Host normal defenses lowered by surgery or illness Hands of Personnel common vehicle for spread of microorganisms Age Duration of Hospitalization Immune Status (decreased resistance) * Chemotherapy * Radiation Therapy * Malignancy Diagnostic Technique and procedures Environment Patient 4 STAGES OF INFECTIOUS PROCESS 1. Incubation Period entry of microorganism to body onset of non specific s/s 2. Prodromal Period onset of non specific s/s appearance of specific s/s 3. Illness Period specific s/s develop and become evident 4. Convalescent Period s/s start to abate (decrease) client returns to normal state of health.
CHAIN OF INFECTION 1 ST - ETIOLOGIC / INFECTIOUS AGENT Microorganism (bacteria, virus, fungi, or parasite) capability to produce infection depends on no. of microbes, pathogenicity, ability to enter body, susceptibility of host, and ability to live on the hosts body. Ability of agent to cause disease depends on the microorganisms pathogenicity, virulence, invasiveness, and specificity (organisms attraction to a specific host)
2 ND - RESERVOIR (SOURCE OF MICROORGANISM) humans (most common; clients, visitors, health care personnel) clients own microorganism animals (insects, rat) plants inanimate objects general environment (air, water, soil, food, feces)
3 RD - PORTAL OF EXIT FROM RESERVOIR Respiratory nose or mouth thru sneezing, coughing, breathing, talking; droplets, sputum GIT mouth (vomitus, saliva), anus (feces), ostomies, drainage tubes Urinary urethral meatus (urine, urethral catheters); anus (feces and colostomies) Reproductive vaginal discharge, semen Blood open wound, needle puncture site Tissue drainage from cut or wound
4 th MODES OF TRANSMISSION
1. Contact Transmission - direct / indirect a. Direct Transmission immediate and direct transfer from person to person (body surface->body surface); hands of caregivers - most frequent mode of transmission (ex. Nurses to clients during bathing, dressing changes, insertion of tubes and catheter)
b. Indirect Transmission - susceptible host exposed to contaminated objects such as dressing, needle, surgical instrument
Vehicle Borne Transmission transfer of microorganisms by vehicles or contaminated objects (ex. food, water, milk, blood, utensils, pillows, mattress) Fomites or Inanimate Objects (surgical instruments or dressings, handkerchief, soiled clothes, toys, utensils, surgical instruments / dressings)
Vector Borne Transmission Biologic vectors animals such as rats, snails, mosquitoes; Flying or crawling insects that serves as intermediate means to transport infectious agent. Transmission by injecting the saliva during biting or depositing feces on skin thru wound bite 3. Airborne Transmission Involves DROPLET NUCLEI OR DUST Occurs when fine particles are suspended in the air for a long time or when dust particles contain pathogens. Air current disperses microbes which can be inhaled or deposited on the skin of susceptible host. Droplet Nuclei residue of evaporated droplets emitted by infected host (ex. TB Patient)
5 th PORTAL OF ENTRY TO THE SUSCEPTIBLE HOST Microorganism enters the body of susceptible host by the same route they used to leave the source. Pathogens can enter through body orifices such as mouth, nose, ears, eyes, vagina, rectum, or urethra. Breaks in skin / mucous membranes from wounds or abrasions increases chance for organisms to enter host.
6 th SUSCEPTIBLE HOST - Person at risk for infection whose own body defense mechanisms, when exposed are unable to withstand the invasion of pathogens
Susceptibility degree in which individual can be affected
Compromised Host person at increased risk, more likely than others to acquire infection; normal defenses have been lowered. Malnourished children client w/ leukemia Impaired natural defenses Age (very young and very old) Clients receiving immunosuppressive treatment for CANCER Clients with immune deficiency conditions Following a successful organ transplant
Factors influencing the Hosts Susceptibility Intact skin and mucous membrane are bodys 1 st line of defense Normal PH LEVELS of secretions and of genito-urinary tract help ward off microbial invasion Bodys WBC influence resistance to certain pathogens Immunization (natural/acquired), acts to resist infection Fatigue, climate, general health status, presence of pre-existing illness, previous or current treatments and some medications may play part in the susceptibility of a potential host.
BODY DEFENSES AGAINST INFECTION (NONSPECIFIC / SPECIFIC) 1. NON SPECIFIC Protect the person against all microorganisms, regardless of prior exposure Includes anatomic and physiologic barriers Intact Skin 1 st line of defense unless cracked or broken; dryness is also deterrent to bacteria. Bacteria are plenty in moist areas such as perineum and axillae. Resident bacteria of skin also prevent other bacteria from multiplying. normal secretions make skin slightly acidic that inhibits bacteria. Nasal Passages (has cilia that trap microbes, dust, and foreign material) Oral Cavity (saliva contains microbial inhibitors such as lactoferin, lysozome,etc) Eye (protected by tears which wash microbes away and contain lysozome) Lungs (has alveolar macrophages II large phagocytes) GIT (high acidity prevents microbial growth; peristalsis moves microbes out) Vagina (has natural defenses; when a girl reach puberty, lactobacilli ferment sugars in vaginal secretions creating PH 3.5-4.5- this low PH inhibits growth of pathogens Urethra (urine flushes bacteria) INFLAMMATORY RESPONSE Local and non specific response of tissues to infectious agent An adaptive mechanism that destroys injurious agents and prevents further spread of injury and promotes repair. ENDING IN ITIS describes INFLAMMATORY PROCESS Characterized by: a. Pain or Dolor b. Swelling or Tumor c. Redness or Rubor d. Heat or Color/Calor e. Impaired function of the part if severe injury
INJURIOUS AGENTS 1. Physical Agents mechanical objects causing trauma to tissues, excessive heat or cold, radiation, UV Rays 2. Chemical Agents strong acids and bases, alkalis, poisons, gases 3. Microorganisms
3 STAGES OF INFLAMMATORY RESPONSE 1. Vascular and Cellular Response 2. Exudates Production 3. Reparative Phase (Regeneration and Fibrosis) * Fibrosis - formation of excess fibrous connective tissue in an organ or tissue in a reparative or reactive process; SCARRING
2. SPECIFIC IMMUNE DEFENSES a. Anti-body Mediated Defenses (Antibodies or Immunoglobins) b. Cell Mediated Defenses or Cellular Immunity (TCeLLS)
SUPPORTING DEFENSE OF A SUSCEPTIBLE HOST proper hygiene balanced diet adequate fluid intake adequate sleep immunizations stress (nurses can assist to learn stress reducing techniques)
TYPES OF IMMUNIZATION 1. ACTIVE IMMUNIZATION - Antibodies produced by the body in response to infection a. Natural - Antibodies formed in the presence of active infection in the body; IT IS LIFELONG ex. recovery from mumps, chicken pox b. Artificial Antigens (VACCINES OR TOXOIDS) administered to stimulate antibody production; Requires booster inoculation after many years.ex. Tetanus Toxoid, OPV
2. PASSIVE IMMUNIZATION antibodies produced by another source such as animal or human a. Natural antibodies from mother to newborn thru placenta or in colostrums b. Artificial Immune Serum (antibody) from animal or another human is injected (ex. Tetanus Immunoglobin Human TIGH)
BREAKING THE CHAIN OF INFECTION / ASEPTIC PRACTICES 1. HANDWASHING The single most important infection control practice microorganisms are transient floras until hands are washed soap, water, and alcohol based hand rubs are effective preparations for removing transient microorganisms wash hands before and after client contact Medical asepsis - hands LOWER than elbows. Hands are more contaminated than elbows. Use running water, soap & friction for 15 30 secs each hand turn off faucet with clean paper towel. Always wear gloves during client care when skin is abraded. 2. CLEANING, DISINFECTION, STERILIZATION a. Cleaning physical removal of dirt and debris by washing, dusting, or mopping contaminated surfaces
b. Disinfection Chemical or physical process to reduce no. of potential pathogens on surface but not necessarily the spores.
Disinfectant chemical preparation used on INANIMATE OBJECTS (ex. Phenol); have bactericidal and bacteriostatic properties
Antiseptic chemical preparation used on SKIN OR TISSUE; have bactericidal and bacteriostatic properties
Bactericidal destroys/kills bacteria; chemical that kills microorganisms
Bacteriostatic prevents growth and reproduction of some bacteria; prevents bacterial multiplication
Commonly used anti-septics and disinfectants Isopropyl alcohol hands and vials Chlorine (bleach) blood spills Hydrogen Peroxide and Phenols surfaces Iodophors equipment; intact skin and tissues if diluted Triclosan (Bacti-stat) hands, intact skin
Types of Disinfection 1. Concurrent Disinfection ongoing practices observed in the care of the client, his supplies, immediate environment, to limit / control spread of microbes. 2. Terminal Disinfection practices to remove pathogens from clients belongings and his immediate environment after his/her illness is no longer communicable
c. Sterilization - Process that destroys all microorganisms, including spores, and viruses Has 4 Common Methods: 1. Steam Sterilization auto-claving using supersaturated steam under pressure o non toxic, inexpensive, sporicidal, penetrates fabric rapidly. o for surgical dressings, surgical linens, parenteral solutions, metals, and glass objects o color indicator strips change color to indicate sterilization o check packaging for integrity and check expiration date to ensure sterility of object
2. Gas Sterilization ETHYLENE OXIDE is a colorless gas that can penetrate plastic, rubber, cotton and other subs. used for oxygen and suction gauges, BP apparatus, stethoscopes, catheters o expensive and requires 2 5 hrs o Ethylene oxide is TOXIC TO HUMANS.
3. Radiation ionizing radiation penetrates deeply to objects; used for drugs, food, and other heat-sensitive items.
4. Chemicals effective disinfectants o all kinds of microbes, act rapidly, work with water, inexpensive, stable in light and heat, not harmful to body tissues, do not destroy articles o Chlorine is used.
5. Boiling Water least expensive for use @ home; for baby bottles boiled for at least 15mins