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Lines of Defense against nfxn.
- Primary Defenses: Skin. Keep moisturized. Intact. GI flora, tears.
- Secondary Defenses: Immunity and symptoms of immune response.
- Tertiary Defenses: Antibodies, B-Cells, etc.
- Factors that Increase Infection Risk: Age, exposure, immunocompromised, environment, fatigue, nutrition, stress, artificial portal of entry.
6 Links in Chain of nfxn
- All have to be present for nfxn to occure. Nurse's job is to break the chain.
What is a fomite?
Inanimate object that carries pathogens to the next host/carrier.
- Stage 1: Local Infection. What does it look like? Erythema, localized
- Stage 2: Exudate appears, sanginous (bloody), purulent (yellow, pus), serous (straw/white)
- Stage 3: Tissue replacement. Keloids.
Stages of nfxn
- Incubation: Are you infectious before you have symptoms? Yup. Pathogens replicating but not enough to cause symptoms.
- Prodromal: “ I don’t feel so good.” Immune response has started.
- Illness: “ Please stay away from me.” Gloves off, knock down drag out fight pathogen vs immune response.
- Decline: Not too fast now. Relax. Take it easy. Let body repair.
- Convalescence: “Oh, if we only knew how long it would take.” Can take a really long time.
Identifications of Classifications
- Systemic: through blood or lymph.
- Primary infection
- Secondary infection
Local or systemic?
- Fever (S)
- Edema (L)
- Pain or tenderness (L)
- Malaise (S)
- Warmth of the area on palpation (L)
- Increased pulse and respiratory rate (S)
Healthcare Associated nfxn (HAIs)
- Acquired in the hospital
- $$$$$ because insurance will not pay hospital for treatment of pt who acquires nocicomial nfxn. Hospital cannot charge pt either. On the hook for their own bill.
- Exogenous nosocomial infection – yuk!
- Pathogen acquired from healthcare environment
- Endogenous nosocomial infection – we all have it! Normal flora multiply and cause infection as a result of treatment
- Iatrogenic infection: usually due to physician or some type of therapy where sterile technique was not complete. Transfered from inanimate object.
- What can you do to prevent HAI’s?
- NPSG’s (National Patient Safety Goals): Use of appropriate hand hygiene
- Prevention of multi-drug resistant organism infection
- Prevention of central line associated blood stream infection
- Prevention of surgical site infection
Drug Resistant Pathogens
- MDRO’s (Mutli Drug Resistant Organism):
- C-diff: Spore forming, sanitizing gels won't work.
Take home message: WASH YOUR FREAKING HANDS ALL THE TIME!!!
Nursing interventions to promote asepsis
- Medical Asepsis:
- REDUCES the number of organisms
- REDUCES the growth and spread of microorganisms
- Objects are considered CLEAN
- Surgical Asepsis:
- Preservation of STERILE field.
- It's either sterile or it's not. No organisms = sterile.
Need at least 15 seconds with all of the above. Combined action --> reduction of microbes.
Implementing CDC guidlines for hygiene.
- Tier I:
- Standard Precautions
- Protects healthcare workers from exposure
- Decreases transmission of pathogens
- Protects clients from pathogens carried by healthcare workers
Types of Tier I standards of precautions.
- Hand washing
- Mask and eye protection
- Disposal of sharps: never thrown in trash, never recapped
Tier II precautions
- Contact Precautions: direct or indirect contact.
- Droplet Precautions: Gloves, gown, mask. Mask can also be worn by you to prevent nfxn to pt.
- Airborne Precautions: Gloves, gown, better (N95) mask (ie for pt with TB).
Basic principles of Isolation cases and hygiene
- Wash hands before entering or leaving an isolation room
- Dispose of contaminated supplies in a manner that will prevent the spread of microorganisms
- Apply knowledge of disease process and mode of transmission when protective barriers are used
- Protection of all persons during transport.
- Pt. will typically be in negative pressure room. TB can be exposure, nfxn, and active. Can also be latent.
Other Isolation precaustions
- C. diff
- EBSL (another resistant organsim)
Personal protective equipment (PPEs)
- KNOW THE CDC GUIDELINES FOR PUTTING ON AND REMOVING PPEs.