Chapter 17

• Stage1 incubation period
• Stage 2 prodromal period
• Stage 3 the illness period
• Stage 4 the convalescent periond

• organism first enters body and last until onset of symptoms
• infection can be transmitted

• short time from onset of vague symptoms to the onset of specific diseases symptoms
• highly infectious

localized and systemic symptoms appear

symptoms begin to subside and continue until the person returns to normal

• surgical incisions with/without drains
• artificial airways
• urinary catheters
• intravenous (IV) lines
• implanted prosthetic devices
• repeated injections or venipunctures
• immune compromise

Healthcare Associated Infection

while receiving healthcare services

isolation

• use medical and surgical asepsis
• standard precautions
• transmission based precautions

Strict aseptic technique

• 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

• Tier 1: standard precautions
• Tier 2: transmission-based precautions

delineate methods for avoiding direct contact with body secretions except sweat

interrupting mode of transmission by identifying specific secretions that might be infective

• standard
• airborne
• droplet
• contact

all patients

• measles
• varicella
• TB (special mask)

• meningitis
• pneumonia
• diptheria

• GI
• skin
• wound infection
• RSV
• herpes simples

• 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*

• 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

• 1st choice private room
• small droplet, can stay in air long time

• 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

Tb, varicella and measles

• onset fatigue
• congestion
• cough
• photophobia
• macular eruption (rash)

• 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

• small blisters
• can lead to encephalitis and meningitis
• life threatening to unborn fetus
• incubation 7-21 days
• full recovery takes weeks

• temperature
• headache
• anorexia
• blister rash

• chicken pox in child
• shingles in adults
• herpes simplex

lesions in mouth can swell throat

• 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

• lesions caused by virus=cold sores on mouth or genital herpes
• drainage from lesions can be contagious on contact

• 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

• cough
• increased and/or bloody sputum
• night sweats
• fever
• weight loss

+ tuberculosis

• larger particle (3 ft guide)
• do not remain in air as long as airborne

• 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

• scarlet fever
• flu
• strep throat

• 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

• temperature
• fatigue/malaise
• joint pain
• swollen lymph nodes
• starts with red spots on palate of mouth

inflammation of salivary glands and parathyroid glands

• 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

• temperature
• headache
• earache
• pain with chewing

inflammation of meninges (membrane lining of Brain and Spinal Cord)

• *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

• temperature
• chills
• *headache*
• *stiff neck*
• AMS
• May have rapid onset requiring emergency treatment

blood or body fluids with potential to contain blood

• 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

• clostridium difficile (c-diff)
• shigella
• impetigo
• scabies
• lice
• conjunctivitis

• contact precaution
• airborne virus
• lesion exudate (drainage) is contact
• can migrate to numerous sites

• 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

inflammation of the liver caused by virus, may also me alcohol or drug induced

• 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

• fatigue
• low grade fever
• nausea/vomiting
• flu-like symptoms
• anorexia
• weight loss
• *jaundice
• itchy skin
• brown urine
• liver enlargement
• abnormal liver functions test

• 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

• 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

• 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

• 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

• 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

• rare, milder effects
• usually only seen in people with hepatitis b

most common in areas with poor water and treatment systems

• remotely related to hepatitis c
• usually milder
• can cause chronic condition

• 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

• MRSA-methicillin resistant staphlococcus  aureus
• VRE-vancomycin resistant enterococcus

• 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

• 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

• 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

• hemorrhagic E-coli
• salmonella
• norovirus-sever cramping, diarrhea-spreads quickly especially among elderly

uses respiratory (airborne) and contact

• 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

• Varicella with open/draining lesion
• SARS (coronavirus)

• 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

• assessment (data collection)
• nursing diagnosis

• assess for signs of infection may require transmission-based precautions
• wounds assessed each shift for infection
• monitor temperature
• admission lab studies may indicate infection

• things nurses can control
• risk for infection
• r/t surgical wound
• open wound
• weakened condition

• expected outcomes include "no healthcare associated infection is evident"
• when using transmission-based precautions that require ppe you must prepare before entry

• 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

• most important in prevention of infection transmission
• before and after contact with patient, wound care, invasive procedure
• before donning gloves and after removal

• disposable gloves
• masks
• gowns
• goggles or face shield

• worn appropriately based on transmission mode
• discard after use in appropriate container
• remove most contaminated items first just before you step outside room

• label container before entering room
• collect specimen
• place in leak proof container without contaminating outside

• handle as little as possible
• roll up and place inside hamper inside patients room

• disposable soiled equipment placed in plastic bags lining waste receptacle
• biohazard (red) bag may be needed

• never recap needle before disposal
• all sharps in sharps container
• replace sharp containers when 2/3 full

reusable equipment cleaned if visibly soiled, then sent to central supply to be disinfected

• institute measures to enhance patients
• examples:
• natural body defenses
• protect intact skin
• promote a balanced diet
• provide opportunity for sleep
• decrease stress

patient who need transmission precautions should be placed in private room or another infected patient with same organism

• avoid unless absolutely unnecessary
• patient given standard mask to wear outside room

• 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

• 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

OSHA regulations protect health care workers from exposure to blood-borne pathogens in workplace

• 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

• know what is sterile
• know what is not sterile
• separate sterile from not sterile
• remedy contamination immediately

keep an area free from microorganisms

• 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

• 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

• 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

• 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

• indications: for viral (non-bacterial) infections
• contraindications/cautions: liver disease, DM, renal disease

many patients on these drugs are immunocompromised

• sustiva
• epivir
• AZT

• zovirax
• valtrx
• abreva
• acyclovir

• symmetrel
• tamiflu
• relenza

• epivir
• ribavirin
• hepsera

• mouth ulcers
• edema
• rash
• itching
• bone marrow suppression
• hyperglycemia
• blood disorders

• numerous based on individual dosage
• avoid OTC including topicals

avoid herbs/supplements

• viruses can become resistant to drugs easily
• teach s/s of pancreatitis, fungal or other secondary infections
• monitor liver and kidney function