Chapter 17

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  1. Four stages in infectious process:
    • Stage1 incubation period
    • Stage 2 prodromal period
    • Stage 3 the illness period
    • Stage 4 the convalescent periond
  2. Stage 1 incubation period
    • organism first enters body and last until onset of symptoms
    • infection can be transmitted
  3. Stage 2 prodromal period
    • short time from onset of vague symptoms to the onset of specific diseases symptoms
    • highly infectious
  4. Stage 3 the illness period
    localized and systemic symptoms appear
  5. Stage 4 the convalescent period
    symptoms begin to subside and continue until the person returns to normal
  6. Patients at great risk for infection include those with:
    • surgical incisions with/without drains
    • artificial airways
    • urinary catheters
    • intravenous (IV) lines
    • implanted prosthetic devices
    • repeated injections or venipunctures
    • immune compromise
  7. HIA
    Healthcare Associated Infection
  8. HIA transmitted
    while receiving healthcare services
  9. Prevent contact between patient and other
  10. Ways to prevent infection and control it
    • use medical and surgical asepsis
    • standard precautions
    • transmission based precautions
  11. Use in invasive diagnostic and therapeutic procedures (IV catheters, urinary catheters, surgical procedures)
    Strict aseptic technique
  12. Infection prevention and control involve
    • monitoring diagnostic reports related to infections
    • observing patients for signs of infection
    • implementing procedures to contain microorganisms
    • properly handling, sterilizing, or disposing of contaminated items
    • using approved sanitation methods
    • recognizing individuals at high risk for infection and implementing appropriate protection
  13. Current standards for infectious prevention and control
    • Tier 1: standard precautions
    • Tier 2: transmission-based precautions
  14. Tier 1: standard precaution
    delineate methods for avoiding direct contact with body secretions except sweat
  15. Tier2: transmission based precautions
    interrupting mode of transmission by identifying specific secretions that might be infective
  16. Transmission-based precautions
    • standard
    • airborne
    • droplet
    • contact
  17. Standard precautions to be taken with
    all patients
  18. Airborne precautions to be taken with
    • measles
    • varicella
    • TB (special mask)
  19. Droplet precautions to be taken with
    • meningitis
    • pneumonia
    • diptheria
  20. Contact precautions to be taken with
    • GI
    • skin
    • wound infection
    • RSV
    • herpes simples
  21. Standard precautions
    • handwashing and gloving
    • do not recap/properly dispose of soiled linen and equipment
    • use mouthpiece or bag/mask for mouth-to-mouth
    • *for all patients*
  22. Transmission based precautions
    • limit contact with staff and visitors
    • signs on doors
    • no shared equipment
    • clean transport mechanisms
    • signs for doors with name of specific type of isolation
  23. Airborne transmission:
    • 1st choice private room
    • small droplet, can stay in air long time
  24. Airborne transmission requirements:
    • negative pressure room
    • staff/visitors immune and wear N95 mask
    • do not touch mask once on
    • requires good asepsis and use of gloves
    • patient wears mask to leave room
  25. Airborne transmission examples:
    Tb, varicella and measles
  26. Measles s/s
    • onset fatigue
    • congestion
    • cough
    • photophobia
    • macular eruption (rash)
  27. Measles (rubeola)
    • rash last 4 to 5 days
    • can result in CNS damage
    • usually gives permanent immunity
    • incubation 8-14 days after exposure
    • vaccine usually given in MMR combination of measles, mumps and rubella
  28. Varicella zoster virus
    • small blisters
    • can lead to encephalitis and meningitis
    • life threatening to unborn fetus
    • incubation 7-21 days
    • full recovery takes weeks
  29. Varicella s/s
    • temperature
    • headache
    • anorexia
    • blister rash
  30. Types of Varicella zoster virus
    • chicken pox in child
    • shingles in adults
    • herpes simplex
  31. Chicken pox in child
    lesions in mouth can swell throat
  32. Shingles in adult
    • reactivate with stress or decreased immunity
    • pain can stay long after rash is gone
    • can reappear more than once
    • post-herpetic neuralgia can be severe
  33. Herpes simplex
    • lesions caused by virus=cold sores on mouth or genital herpes
    • drainage from lesions can be contagious on contact
  34. Tuberculosis
    • priority for private room
    • incubation 4 to 12 wks before may see + test
    • can be positive but non-infective
    • usually requires long term therapy
    • commonly occurs in lungs but can kidney, bone, GI tract
    • mammals, birds and fish can infect humans
    • *6 month therapy
  35. Tuberculosis s/s
    • cough
    • increased and/or bloody sputum
    • night sweats
    • fever
    • weight loss
  36. Estimated 1/3 of the worlds population is
    + tuberculosis
  37. Droplet-precaution
    • larger particle (3 ft guide)
    • do not remain in air as long as airborne
  38. Droplet precautions
    • staff/visitors wear surgical mask to enter room
    • private room or same diagnosis
    • monitor fluid balance and treat symptoms
    • patient wears mask to leave room
  39. Droplet precaution examples
    • scarlet fever
    • flu
    • strep throat
  40. Rubella
    • usually milder than rubeola
    • droplet precaution
    • contagious 10 day prior to appearance of rash
    • incubation 14-23 days
    • can harm fetus during first trimester
    • MMR vaccine
  41. Rubella s/s
    • temperature
    • fatigue/malaise
    • joint pain
    • swollen lymph nodes
    • starts with red spots on palate of mouth
  42. Define mumps
    inflammation of salivary glands and parathyroid glands
  43. Mumps
    • droplet precaution
    • incubation 12-25 days
    • virus present 6 days before and up to 9 days after onset of swelling
    • boys may have swelling in testicles and need support
    • can result in deafness and lead to meningitis
    • usually complete recovery with lifelong immunity
    • Accute stage needs bed rest, fluids, soft foods, non-acid
    • MMR vaccine
  44. Mumps s/s
    • temperature
    • headache
    • earache
    • pain with chewing
  45. Define meningitis
    inflammation of meninges (membrane lining of Brain and Spinal Cord)
  46. Meningitis
    • *most severe
    • severe neurological injury
    • fatal in 10 to 40 percent of cases
    • vaccine recommend for kids and high risk adults
    • deafness in children common
    • requires several weeks of IVAB for bacterial agent
    • viral form treatment is supportive/anti-viral agents
    • may come from mosquito bites
  47. Meningitis s/s
    • temperature
    • chills
    • *headache*
    • *stiff neck*
    • AMS
    • May have rapid onset requiring emergency treatment
  48. Contact-precaution
    blood or body fluids with potential to contain blood
  49. Contact precautions
    • private room or person with same infection
    • do not share equipment
    • nurse and visitors wear gloves
    • *double glove when caring for infected
    • *wear mask, face shield, hair and shoe covers
    • *remove soiled PPE and wash hands immediately before leaving room
    • patient leaves must wear isolation gown and gloves
    • wound site covered, waterproof pad if possible
  50. Contact precaution examples
    • clostridium difficile (c-diff)
    • shigella
    • impetigo
    • scabies
    • lice
    • conjunctivitis
  51. Herpes
    • contact precaution
    • airborne virus
    • lesion exudate (drainage) is contact
    • can migrate to numerous sites
  52. Common kinds of herpes
    • simplex-cold sore
    • genital-very contagious-transmitted to baby during birth with serious complications
    • zoster-shingles-contagious until completely crusted with no new eruptions, pain may remain, may re-erupt or pain may reappear for years
  53. Define hepatitis
    inflammation of the liver caused by virus, may also me alcohol or drug induced
  54. Hepatitis
    • contact precaution
    • easier to transmit than HIV/AIDS
    • some types can remain viable on surface for several days
    • may not have obvious clinical s/s found on physical exam or lab
    • may take months to recover
    • *does not respond to antibiotics, use anti-viral drugs
  55. Hepatitis s/s
    • fatigue
    • low grade fever
    • nausea/vomiting
    • flu-like symptoms
    • anorexia
    • weight loss
    • *jaundice
    • itchy skin
    • brown urine
    • liver enlargement
    • abnormal liver functions test
  56. Treatment and teaching hepatitis
    • standard and contact precautions depending on s/s exhibiting
    • rest
    • no strenuous exercise
    • don't share utensils
    • clean bathroom after each use
    • separate linen
    • wear gloves at even at  home
    • don't share personal items
    • avoid OTC and herbs
    • high calorie/high carbohydrate low fat diet
  57. Types of hepatitis
    • A-fecal/oral route
    • B (HBV)-body fluid contact
    • C (HCV)-body fluid contact
    • D-body fluid contact
    • E-fecal/oral route
    • G-body fluid contact
  58. Hepatitis A
    • poor hygiene, contaminated food or water
    • incubation 2 to 6 weeks
    • acute stage 2 to 12 weeks
    • recovery up to several months
    • immune globulin given early, 90 percent effective, short term
    • Avaxim vaccine available-lasts 10 yrs
    • usually no long term effects, no carrier state or chronic condition
  59. Hepatitis B (HBV)
    • can live outside body
    • 300 million cases worldwide
    • vaccine recommended for healthcare workers, high risk and school children
    • incubation 8 weeks to 6 months
    • can survive up to a week on dried blood
    • may be asymptomatic to severe
    • lead to hepatitis or cirrhosis or liver cancer
    • *no cure-supportive treatment
  60. Hepatitis C (HCV)
    • most common in chronic bloodborne infection in US
    • over 30,000 new cases a yr
    • may be mild or asymptomatic
    • has more chronic carriers
    • more of this type leads to cirrhosis and liver cancer
    • many don't know how or when exposed
    • no post exposure treatment or vaccine currently
  61. Hepatitis D
    • rare, milder effects
    • usually only seen in people with hepatitis b
  62. Hepatitis E
    most common in areas with poor water and treatment systems
  63. Hepatitis G
    • remotely related to hepatitis c
    • usually milder
    • can cause chronic condition
  64. Antibiotic resistant organism
    • isolation signs may state specific name or ARO
    • most commonly found in wounds
    • can colonize in skin, wounds, GI tract, respiratory and urinary systems
    • may clear after time or remain positive
    • handwashing with antimicrobial soap
    • careful handling of supplies and equipment
    • visitors may not wish to wear gloves but must if visiting other patients
  65. Examples of antibiotic resistant organisms
    • MRSA-methicillin resistant staphlococcus  aureus
    • VRE-vancomycin resistant enterococcus
  66. HIV-human immunodeficiency virus
    • contact precautions
    • virus causes aids
    • damage immune system-destroys B&T lymphocytes
    • may be + for yrs with no s/s of active disease
    • may be + and never convert to active AIDS
    • if + can be transmitted
    • can not live outside a live host
  67. AIDS-acquired immune deficiency syndrome
    • contact precautions
    • mother can pass to baby through placenta
    • dementia can occur in advanced stages
    • standard precautions unless
    • can not live outside a live host
    • can not get by casual contact
    • if responds to treatment can live for many yrs
    • may die from secondary infections
  68. Enteric
    • fecal/oral route (found in stool)
    • usually severe diarrhea
    • may have significant weight lose
    • gown, double glove, mask/shield
    • keep linen clean, bed disinfected
    • clean bathroom after each use
  69. Examples of enteric
    • hemorrhagic E-coli
    • salmonella
    • norovirus-sever cramping, diarrhea-spreads quickly especially among elderly
  70. Combination-precaution
    uses respiratory (airborne) and contact
  71. Combination precautions
    • use all ppe=face shield, N-95 mask, gown, gloves
    • patient wears mask to leave room
    • use antiseptic hand wash
    • clean area well
    • clean bathroom after each use
    • do no share equipment, utensils
  72. Examples of combination precautions
    • Varicella with open/draining lesion
    • SARS (coronavirus)
  73. Guidelines for patient care contact
    • never touch anything with bare hands
    • gloves for contact of body fluids of any sort
    • only time gloves not worn is in contact with intact skin or unsoiled articles
  74. Application of nursing process
    • assessment (data collection)
    • nursing diagnosis
  75. Assessment (data collection)
    • assess for signs of infection may require transmission-based precautions
    • wounds assessed each shift for infection
    • monitor temperature
    • admission lab studies may indicate infection
  76. Nursing diagnosis
    • things nurses can control
    • risk for infection
    • r/t surgical wound
    • open wound
    • weakened condition
  77. Planning
    • expected outcomes include "no healthcare associated infection is evident"
    • when using transmission-based precautions that require ppe you must prepare before entry
  78. Implementation
    • patient teaching needed on disease process, modes of transmission, and precautions to prevent spread of infection
    • standard precautions used for every patient
    • transmission-based precautions implemented based on patients infection status
  79. Implemenation-hand hygiene
    • most important in prevention of infection transmission
    • before and after contact with patient, wound care, invasive procedure
    • before donning gloves and after removal
  80. Implemenation-PPE
    • disposable gloves
    • masks
    • gowns
    • goggles or face shield
  81. PPE
    • worn appropriately based on transmission mode
    • discard after use in appropriate container
    • remove most contaminated items first just before you step outside room
  82. Specimen removal in isolation precautions
    • label container before entering room
    • collect specimen
    • place in leak proof container without contaminating outside
  83. Linens in isolation precautions
    • handle as little as possible
    • roll up and place inside hamper inside patients room
  84. Guidelines for isolation precautions-trash
    • disposable soiled equipment placed in plastic bags lining waste receptacle
    • biohazard (red) bag may be needed
  85. Guidelines for isolation precautions-sharps
    • never recap needle before disposal
    • all sharps in sharps container
    • replace sharp containers when 2/3 full
  86. Guidelines for isolation precaution-other equipment
    reusable equipment cleaned if visibly soiled, then sent to central supply to be disinfected
  87. Guidelines for isolation precautions-natural defenses
    • institute measures to enhance patients
    • examples:
    • natural body defenses
    • protect intact skin
    • promote a balanced diet
    • provide opportunity for sleep
    • decrease stress
  88. Guidelines for isolation precautions-patient placement
    patient who need transmission precautions should be placed in private room or another infected patient with same organism
  89. Guidelines for isolation precautions-transporting patient
    • avoid unless absolutely unnecessary
    • patient given standard mask to wear outside room
  90. Infection prevention and control in home
    • keep clothes and linen away from others
    • teach patient and family proper hand hygiene techniques
    • disinfect bathroom 1:10 bleach/water solution
    • wash dishes in scalding water and let air dry
    • use heavy plastic jug with secure top to hold needles
    • use clean gloves for wound care and dressing
    • teach family how to remove soiled gloves
    • clean patient room frequently
  91. Protective isolation
    • special room with its own ventilation
    • no one with active infection allowed in room
    • remain aware of your facilities policies and procedures and follow at all times
  92. Infection prevention and control for the nurse
    OSHA regulations protect health care workers from exposure to blood-borne pathogens in workplace
  93. Three main modes of occupational exposure to blood-borne pathogens
    • puncture wounds-contaminated needles or other sharps
    • skin contact-allowing blood, body fluids, other potential infectious materials to enter through damaged or broken skin
    • mucous membrane contact-allowing infectious materials through mucous membranes of eyes, mouth, nose
  94. Four rules of surgical asepsis
    • know what is sterile
    • know what is not sterile
    • separate sterile from not sterile
    • remedy contamination immediately
  95. Goal for surgical asepsis
    keep an area free from microorganisms
  96. Surgical scrub
    • more lengthy and vigorous hand hygiene
    • remove as many microorganisms as possible without damaging skin
    • timing based on actual time spent scrubbing not including rinse time
    • usually 2 to 4 minutes
    • brushless technique with antimicrobial agent may be used
  97. Opening sterile packages
    • perform hand hygiene
    • open away from body
    • touch only outside wrapper
    • do not reach across a sterile field
    • always face sterile field
    • allow at least 6 inches between body and sterile field
  98. Evaluation
    • Patient recovering without additional infection from other organisms or other body areas
    • Assessing if patients has been transmitted to any healthcare worker or patient in hospital or unit
  99. Gerontologic considerations
    • elderly often have poor nutrition
    • may have atypical s/s of infection & more severe complications
    • many LTC and elderly colonized with antibiotic resistant bacteria
    • pneumonia, influenza, UTI, skin infections, TB common in elderly especially in LTC
    • may have invasive procedures: pacemakers, catheters, feeding tubes
    • need immunizations
  100. Drugs anti-viral agents
    • indications: for viral (non-bacterial) infections
    • contraindications/cautions: liver disease, DM, renal disease

    many patients on these drugs are immunocompromised
  101. Common drug for HIV/AIDS
    • sustiva
    • epivir
    • AZT
  102. Common drug for varicella/herpes
    • zovirax
    • valtrx
    • abreva
    • acyclovir
  103. Common drug for Influenza
    • symmetrel
    • tamiflu
    • relenza
  104. Common drug for hepatitis
    • epivir
    • ribavirin
    • hepsera
  105. Side effect for anti-viral agents
    • mouth ulcers
    • edema
    • rash
    • itching
    • bone marrow suppression
    • hyperglycemia
    • blood disorders
  106. Drug interactions for anti-viral agents
    • numerous based on individual dosage
    • avoid OTC including topicals
  107. Food interactions for anti-viral agents
    avoid herbs/supplements
  108. Teaching/nursing considerations for anti-viral agents
    • viruses can become resistant to drugs easily
    • teach s/s of pancreatitis, fungal or other secondary infections
    • monitor liver and kidney function
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Chapter 17
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