Stress of Infection
Terms
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- antibody
- immunoglobin produced by the body in response to a specific antigen
- antigen
- foreign material, usually a bacteria, capable of inducing a specific immune response
- asepsis
- absence of disease producing microorganisms; being free of infection
- carrier
- person or animal who is without signs of illness but who has pathogens on or within body that can be transferred to others
- Centers for Disease Control (CDC)
- U.S. government agency whose responsibilities include investigation, identification, prevention and control of disease
- colonization
- harmless growth of microorganisms in or on the body
- convalescent period
- stage of an infection that represents recovery from the infection
- disinfectant
- substance, usually intended for use on inanimate objects, that destroys pathogens, but generally not spores
- disinfection
- process by which pathogens, but not spores, are destroyed
- endogenous
- infection in which the causative organisms comes from microbial life the person himself harbors
- exit from reservoir
- point of escape or organisms from a reservoir
- exogenous
- infection in which the causative organism is acquired from another person
- fomite
- inanimate object other than food that can absorb and transmit infectious material
- full stage of illness
- stage of an infection characterized by the presence of specific signs and symptoms
- host
- animal or person on which or within which microorganisms live
- iatronic infection
- infection that occurs as a result of a treatment or diagnostic procedure
- immune response
- specific reactions in the body as it responds to an invading foreign protein such as bacteria, or even in some cases, the body's own protein
- incubation period
- stage of infection that includes the interval between the invasion of the body by the pathogen and the appearance of symptoms of infection
- infection
- disease state resulting from pathogens in or on the body
- inflammatory response
- localized response of the body to injury or infection; protective mechanism that eliminates invading pathogens and allows for tissue repair to occur
- isolation
- protective procedure designed to prevent the transmission of specific microorganisms; also called protective aseptic technique and barrier techniques
- localized symptoms
- symptoms that are limited or restricted to a discrete area
- medical asepsis
- practices designed to reduce the number and transfer of pathogens; synonym for clean technique
- normal flora
- microorganisms that normally inhabit various body sites and are part of the body's natureal defense system
- nosocomial infection
- hospital acquired infection
- pathogen
- disease producing microorganism
- portal of entry
- point at which an organism enters a host
- prodromal stage
- stage of an infection when a person is most infectious. Eary signs and symptoms of a disease are present but are vague and non-specific
- reservoir
- natural habitat for the growth and multiplication of microorganisms
- resident flora or bacteria
- microorganisms that normally live on a person's skin
- sterilization
- (1) the process by which all microorganisms, including spores are destroyed; (2) surgical procedure performed to render a person infertile
- surgical asepsis
- practices that render and keep objects and areas free from microorganisms; synonym for surgical technique
- susceptibility
- degree of resistance of a host to a pathogen
- systemic symptoms
- symptoms manifested throughout the entire body
- transient flora or bacteria
- microorganisms picked up on the skin as a result of normal activites which can be removed readily
- vector
- non-human carrier; usually an anthropoid that transfers pathogens from one host to another
- vehicle
- means for transmitting organisms
- virulence
- ability to produce disease
- cell-mediated immunity
- T lymphocytes meet antigen and release lymphokines
- complement
- an inactive protein in blood that is activated when antigen and antibody bind together
- humoral immunity
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stimulates B lymphocytes which result in the formation of antibodies
natural immunity
acquired immunity - interferon
- a protein that interferes with the ability of viruses to multiply
- 4 stages of infection
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incubation period
prodromal stage
illness stage
convalescence stage - Body's Defense Mechanisms
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The body has unique defenses against infection
Conditions that impair an organ's specialized defense increases the susceptibility of infection - Body's Defense Mechanisms: Skin
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First line of defense
Intact multi-layered surface
Shedding of the outer layer
Sebum contains fatty acids - kill some bacteria - Body's Defense Mechanisms: Mouth
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Intact multi-layered mucosa
Saliva washes away particles - Body's Defense Mechanisms: Respiratory Tract
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Cilia line the upper airways
Macrophages engulf and destroy - Body's Defense Mechanisms: Urinary Tract
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Flushing action of urine flow
Intact multi-layered epithelium - Body's Defense Mechanisms: Vagina
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Normal flora cause vaginal secretions to achieve lower pH
pH inhibits growth of microorganisms - Body's Defense Mechanisms: GI Tract
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Acidity of gastric secretions
Rapid peristalsis in small intestine - Body's Defense Mechanisms: Normal flora
- Microbes that normally reside on and in the body
- Body's Defense Mechanisms: Inflammatory response
- Protective reaction that neutralizes pathogens and repairs body cells
- Immune Response: Types of immunity (Cell-mediated immunity)
- T lymphocytes meet antigen and release lymphokines
- Immune Response: Types of immunity (Complement)
- An inactive protein in blood that is activated when antigen and antibody bind together (causes bacteria to be killed)
- Immune Response: Types of immunity (Humoral immunity)
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Stimulates B lymphocytes which result in the formation of antibodies
-natural immunity
-acquired immunity (immunizations) - Immune Response: Types of immunity (Interferon)
- A protein that interferes with the ability of viruses to multiply
- Chain of Infection - The "LINKS" in the Chain of Infection
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Portal of Entry
Host
Infectious Agent
Reservoir
Portal of Exit
Mode of Transmission - Chain of Infection: Infectious Agent
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Microorganisms (Pathogens)
Resident
Transient
Potential for organisms to cause disease depends on
Number of organisms
Virulence (strength)
Ability to enter and survive
Susceptibility of the host - Chain of Infection: Reservoir
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Organisms need a proper environment to thrive
-Food
-Oxygen
-Water
-Temperature
-pH
-Light - Chain of Infection: Portals of Exit
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Infectious organisms leave the reservoirs of the host through the following body secretions
-Skin and Mucous membranes
-Respiratory tract (coughing, sneezing)
-Blood
-Reproductive tract (semen and vaginal secretions)
-Additionally, urine (contaminated), stool, saliva and tears - Chain of Infection: Mode of Transmission
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Spread of the infectious organism
-Contact
-Airborne
-Vehicle
-Vectors - Chain of Infection: Portal of Entry
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Enter through the same routes they exit
-Breaks in the skin
-Respiratory tract
-GU tract
-GI tract
-Circulatory system - Chain of Infection: Susceptible Host
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Susceptibility
-Degree of resistance
-Immune system
-More virulent the organism the greater the susceptibility
-Antibiotic resistant organisms - The Chain of Infection
- It is crucial for nurses to follow infection control practices to break the chain
- 4 Stages of Infection: Incubation Period
- Interval from entrance to appearance of illness (generally you're not aware of this)
- 4 Stages of Infection: Prodromal Stage
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First symptoms appear (onset of non-specific symptoms)
Microorganisms grow and multiply
Disease is more likely to be spread - 4 Stages of Infection: Illness Stage
- Full stage of illness - S&S specific to illness
- 4 Stages of Infection: Convalescence Stage
- Symptoms start to disappear
- Techniques to Interrupt the Chain of Infection: Hand Hygiene
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Most basic and important technique in preventing and controlling the transmission of infections
Contaminated hands are the primary cause of cross infection
10-15 seconds of vigorous, rubbing together of hands using soap will remove most transient organisms from the skin (CDC)
Alcohol-based waterless antiseptics are recommended when hands are not visibly soiled (CDC) - Techniques to Interrupt the Chain of Infection
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Client and staff education
-Handwashing
-Airflow control
-Aseptic technique
-Control of excretions and secretions
-Disinfection/sterilization methods
-Environmental sanitation
-Employee health services
-Proper food handling
-Rapid and accurate identification of organisms
-Recognition of high risk clients
-Trash and waste disposal
-Treatment of underlying diseases - Barrier Techniques: Gowns
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Gowns
protects against soiling clothing
Must be long enough to cover all garments
For visitors coats, hats, and gloves need to be removed before donning gown
Cross gown in back and tie - Barrier Techniques: Masks
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Prevents inhalation of microorganisms
Clients on respiratory precautions
Mask discourages wearer from touching eyes, nose and mouth
Properly applied fits snugly
Talking should be kept to a minimum
Moist masks are ineffective
When discarding place inner surfaces together
Can cause feeling of smothering - Barrier Techniques: Gloves
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Single use disposable gloves
Pull cuffs of gloves over cuffs of gown
Change and reapply if they become soiled and explain this to visitors
Not a substitute for hand washing
Prevent the transmission of pathogens by direct and indirect contact - Barrier Techniques: Private room
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Keep door closed (negative pressure)
Post a sign outside the door
Needs to have bathing, hand washing, and toileting facilities
Personnel and visitors need to wash hands before entering and after leaving the room
Supplies are stored on a cart outside the room
May double bag linen and other contaminated articles
A disposable container for sharps
Avoid taking in equipment that is to be reused outside the isolation room - Psychological Implications
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Deprives the client of normal social relationships which can be psychologically harmful
Client's body image may be altered - Standard Precautions
- CDC recommends that health care workers consider all clients as potentially infected and general principles should be followed as standard precautions
- Droplet Precautions
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Private room placement or in room with a client with same infection
Wear mask and stay within 3 feet of patient otherwise you're at risk of infection
Limit transport of client from room - Airborne Precautions
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Private room
Negative pressure
Mask or Respiratory Protection Device
Special masks N95 respirators-need to be fit-tested to mask (gain or lose weight or shave facial hair - mask would require refitting)
Client to wear mask when transported - Contact Precautions
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Private room or a room with a client who has the same infection
Wear gown and gloves
Limit transport and maintain precautions at all times
Use disposable equipment when possible
Wash hands after glove removal and before leaving the client's room - Specimen Collection
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Be sure to use disposable gloves and/or sterile equipment
Seal all containers tightly
Label properly (label the actual container) - Bagging articles
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Prevents accidental exposure to contaminated articles
Leftover food placed in plastic bag with disposable tray and paper/plastic ware
Dispose of dressings and other contaminated articles properly
Double bagging can be used - Outcomes
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Adaptive (favorable outcome)
-Resolution of infectious process with the client returning to baseline
Maladaptive
-Wound disruption (delayed healing)
-Generalized systemic infection that can be life threatening and lead to system failure - Nursing Diagnosis
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Risk for or infection
Social isolation
Diversional activity deficit
Risk for injury
Disturbed body image
Risk for or impaired skin integrity
Imbalanced nutrition: less than body requirements - Planning (goals may include)
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Client will:
-identify signs of infection by ...
-relate the need to be isolated until noninfectious by ...
-demonstrate appropriate cleansing and disinfecting techniques by ...
-describe mode of transmission of disease by ... - Nursing Interventions
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Use strict aseptic technique
Encourage adequate fluid intake
Ensure adequate nutritional intake
Maintain appropriate isolation precautions
Encourage adequate rest
Immunizations to protect client from invasion of pathogens - Evaluation
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Assessment and documentation of goals for reducing or preventing infection
Interventions may need to be changed if goals were unmet
Clear documentation of client's baseline - Infection Control Nurse (QA)
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Keeps all statistics on nosocomial infections
Checks culture reports
Education/inservices
Reports all communicable diseases to the Board of Health
Assists with special precautions
Resource person