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INFECTION

How are organisms transmitted? Direct Contact Person to Person Staff to Patient Patient to Staff. INFECTION. Indirect Contact. Other way than touching an infected person Fomite- Inanimate object 1. Dust 2. Moisture droplet- aerosol effect -talking

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INFECTION

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  1. How are organisms transmitted? Direct Contact Person to Person Staff to Patient Patient to Staff INFECTION

  2. Indirect Contact • Other way than touching an infected person • Fomite- Inanimate object 1. Dust 2. Moisture droplet- aerosol effect -talking -washing instruments 3. Food - cream pie 4. Water - stream 5. OR table 6. Drinking cup Vector- Something capable of moving organisms by itself Flies Tics Mosquitoes

  3. What is necessary for infection to occur? Invasion into the body • Pathogenic organisms enter • Pathways 1. Body orifices 2. Ducts 3. Lumen of broken vessel a. Veins have sinuses and low pressure b. CNS has rich nutrients and low pressure

  4. Condition of patient • Decreased inflammatory response • Absence of anatomic barriers • Local spread of organisms on/in surface of wound -Necrotic tissue • Systemic -Colonies increase -Can be carried throughout the body (Any body fluid/substance is potential carrier of pathogens) -Lymphatic system -Blood-borne • Major organs effected • Multisystem organ failure and death

  5. Number (dose) • Grow in a system or localized area • Supported by -Warmth -Darkness -Moisture -Neutral pH -Nutrients

  6. Virulence and Toxigenicity • Presence of spores, capsules, etc. • The relative ability of a microbe to cause disease • Ability to make toxins: -Endotoxins=from the cells of dead microorganisms -Exotoxins=From the living cell

  7. PORTALS OF ENTRY • Eyes • Ears • Nose • Mouth (respiratory tract, gastrointestinal) • Urethra • Vagina • Rectum • Broken skin • Placenta

  8. Portals of Exit • Eyes • Ears • Nose • Mouth (respiratory tract, gastrointestinal) • Urethra • Vagina • Rectum • Broken skin

  9. PROTECTION • Standard Precautions • How to protect your portals of entry • Potentially infectious-Considering that everyone could potentially have an infection, even though they may not know.

  10. Potentially Infectious Materials • Blood and body fluids • Urine • Fecal material • Respiratory secretions • Saliva • Tears • Semen and Vaginal Secretions • Breast milk

  11. CDC—Center For Disease Control • 2 million acquire nosocomial infections • 77,000 die • Costs 4 + billion dollars to treat

  12. Considerations for Nosocomial Infections • Identify the reservoir • ID the portal of exit from the reservoir • ID how they are transmitted • ID invasion of the susceptible host

  13. Infectious Process • Local infections -Occur as a result of: a. Preoperative Injury b. Postoperative complication (usually begins between the 4th and 8th post op day; usually begins with inflammation c. Abscess formation (inflammatory response, Tissue liquefaction and pus formation)

  14. Regional Infection • Localization by abscess formation fails • Spreads 1) carried from primary site by lymphatic system ( spreads to other areas; Lymphangitis) 2) Failure by nodes to control (uncontrolled cellulitis; may become systemic

  15. Systemic Infection • Chills, fever, signs of toxicity • Septic emboli enter circulation (causes infection/abscess formation in remote tissues • Increases metabolism (stresses body organs, produces septic shock) • GOAL is To Prevent Infection

  16. Once Infection has Occurred • Identify the organism (s) • Identify the hosts immune response 1. Immunologic and inflammatory response 2. Lysis of microorganisms 3. Resorption of pus 4. Sloughing of necrotic tissue 5. Healing occurs

  17. Appropriate Treatment • Drain • Debridement • Antibiotics

  18. Who is at Risk? • Perioperative Staff • Patient

  19. Perioperative Staff • Protect with PPE’s (Standard Precautions) • Risk is proportionate to proximity to patient • Increased risk of needle sticks and punctures See statistics: Blue Packet Page 4

  20. Patient • Needle sticks may stick the staff first • Some are vulnerable to infection: 1. Immunosuppression 2. Immature immune system 3. Radiation Therapy 4. Burns 5. Diabetes 6. Nutritional depletion 7. Smoking and Alcoholism 8. Chemotherapy 9. Older Patients 10. Steroid Use 11. Sickle cell disease 12. Liver and Kidney Disease 13. Pre existing infection 14. Being treated with antibiotics SUPER INFECTION

  21. Sources of Infection • Exogenous infection = Acquired from sources outside the body. • Community: Natural Process • Communicable Infection: Direct contact with another infected person • Environment: Cross contamination by another patient or an inanimate object-Fomite

  22. Exogenous or Endogenous • Acquired from sources outside the body or inside the body. • Nosocomial Infection Most are related to: a. Urinary tract b. Wound Infection c. Respiratory Tract d. Venous access points

  23. Endogenous • Acquired from sources within the body • Most wound infections seed by endogenous organisms. • Spontaneous infection a. Appendicitis b. Cholecystitis c. Bowel perforation

  24. What is necessary for an infection? • Introduction of virulent microorganism • Into a receptive wound or susceptible host • May occur as a result of introduction at time of procedure • Secondary contamination is uncommon *Fibrin seals wound with in hours

  25. Stages of Infection • Incubation • Prodromal • Acute • Convalescent

  26. ACUTE: Rapid course • CHRONIC: Occurs over a long time a. Fungal infections b. Bone infections

  27. Classifications of Post op Wound Infections • Incisional infection a. At the site b. Within 30 days c. Involved skin and subcutaneous d. Area is inflamed and sore e. Purulent drainage ID culture f. Usually I & D by surgeon

  28. Deep Wound Infection: a. At the site b. Within 30 days c. Within 1 year of implant d. Involves tissues or spaces beneath the fascia e. Pus may be present f. May open and drain g. May remove implant

  29. Prevention of Wound Infections • Adherence to aseptic technique, standard precautions • Control of endogenous infection • Meticulous surgical technique • Reduction of exogenous or environmental sources of contamination • Thorough prompt cleaning and debridement of traumatic wounds • Prevention of contamination of a wound intraoperatively • Appropriate use of prophylactic antibiotics • Frequent hand washing • Sterile technique for dressing changes

  30. Necessities to assess a wound postoperatively • Location • Color: Red and pink = Healing White and Yellow = Pus Black = Necrotic Red and Swollen = Infection Macerated – Better collection of drainage from wound. • Perfusion of tissues • Size of infected area • Temperature of site and patient • Dressing conditions/Type • Drainage or drainage devise

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