Chapter 25

1. Chapter 25 Care of Patients with Infection Mrs. Kreisel MSN, RN NU130 Adult Health 1 Summer 2011

2. Definitions • Pathogen—any microorganism capable of producing disease • Communicable—infection transmitted from person to person • Pathogenicity—the ability to cause disease • Virulence—the degree of communicability

3. Definitions(Cont’d) • Normal flora—characteristic bacteria of a body location; it often competes with other microorganisms to prevent infections • Colonization—the microorganism present in tissue but not yet causing symptomatic disease • Surveillance—the tracking and reporting of infections

4. Overview of Chain of Infection • Reservoirs • Pathogens: • Toxins • Exotoxins: A toxin produced by a microorganism and excreted into its surrounding tissue. (liquid medium, unstable, light, heat and chemical sensitivity) • Endotoxins: bacterial toxin confined within the body of the bacterium, freed only when the bacterium is broken down. • Host Defenses: • Susceptibility

5. Immunity • Resistance to infection is usually associated with the presence of antibodies or cells acting on specific microorganisms. • Passive immunity is of short duration, either naturally by placental transfer or artificially by injection of antibodies. • Active immunity lasts for years and occurs naturally by infection or artificially by stimulation (vaccine) of immune defenses

6. Antibodies

7. Antibodies Mechanism of Action

8. Portal of Entry Sites • Respiratory tract • GI tract • Genitourinary tract • Skin/mucous membranes • Bloodstream

9. Mode of Transmission • Contact transmission by direct or indirect contact • Droplet transmission such as in influenza • Airborne transmission such as in tuberculosis • Contaminated food or water • Vector-borne transmission involving insect or animal carriers, such as in Lyme disease • Portal of exit

10. Physiologic Defenses Against Infection • Body tissues • Phagocytosis • Inflammation • Immune systems: • Antibody-mediated immune system • Cell-mediated immunity

11. Infection Control in Inpatient Health Care Agencies • Health care–associated Infection (HAI) is acquired in the inpatient setting; not present at admission. • Endogenous infection is from a patient’s flora. • Exogenous infection is from outside the patient, often from the hands of health care workers.

12. Methods of Infection Control • Practice hand hygiene and proper handwashing. • Personal protective equipment (PPE).

13. Nurse in Personal Protective Equipment Caring for Patient in Protective Isolation Room EDUCATION TO FAMILY ABOUT PPE

14. Infection Control • Adequate staffing • Sterilization: free from all microorganisms and spores • Disinfection: Kills most microorganisms but not spores • Patient placement: • Cohorting: pts with same illness placed together • Patient transportation: PPE if necessary

15. CDC and Prevention Transmission–Based Guidelines • Standard Precautions: • Respiratory hygiene/cough etiquette (RH/CE) • Safe injection practices

16. Transmission-Based Precautions • Airborne Precautions • Droplet Precautions • Contact Precautions • KNOW PAGE 447

17. Methicillin-Resistant Staphylococcus Aureus (MRSA) • Vancomycin • Linezolid • Community-associated MRSA • The best way to decrease the incidence of this growing problem is health teaching • CONTACT PRECAUTIONS/ISOLATION

18. Other Multi Drug Resistant Organisms (MDROs) • Vancomycin-resistant Enterococcus (VRE) • Multidrug resistant tuberculosis • Gonorrhea • Vancomycin-intermediate Staphylococcus aureus (VISA) • Vancomycin-resistant S. aureus (VRSA)

19. Problems from Inadequate Antimicrobial Therapy • Noncompliance (deliberate) or nonadherence (accidental) • Legal sanctions that compel a patient to complete treatment, such as in the instance of tuberculosis (Directly Observed Therapy DOT) • Septicemia • Septic shock

20. Collaborative Care • History • Physical assessment and clinical manifestations • Psychosocial assessment • Laboratory assessment including: • Culture and antibiotic sensitivity testing • Complete blood count • Erythrocyte sedimentation rate • Serologic testing • Imaging assessment

21. Community-Based Care • Home care management • Health teaching • Health care resources

22. NCLEX TIME

23. Question 1 How many inpatients acquire health care–associated infections yearly? • 500,000 • 1,000,000 • 1,500,000 • 2,000,000

24. Question 2 Cleansing hands with alcohol-based hand rubs is appropriate in which situation? • After administering medications to a patient • After working with a patient who has diarrhea due to Clostridium difficile • After using the bathroom • To cleanse visibly soiled or sticky hands

25. Question 3 A patient who has been admitted for newly diagnosed tuberculosis will be placed on which Transmission-Based Precaution? • Droplet Precautions • Airborne Precautions • Respiratory Precautions • Contact Precautions

26. Question 4 A patient may have infectious mononucleosis and is awaiting laboratory confirmation of this diagnosis. If the results are positive for infectious mononucleosis, the nurse would expect to see which laboratory result? • Increased neutrophil levels • Decreased neutrophil levels • Decreased erythrocyte sedimentation rate • Increased lymphocyte levels

27. Question 5 Which person has the highest risk for having Clostridium difficile–associated disease (CDAD)? • A poultry farm worker • A person who has eaten a hamburger that was cooked rare • A 2-year-old patient who has received IV antibiotics for a week • An 82-year-old patient who has received IV antibiotics for a week