chapter 26 infection control. 26-2 copyright 2004 by delmar learning, a division of thomson...
TRANSCRIPT
Chapter 26
Infection Control
26-2Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Infection Control
Infection control practices are directed at controlling or eliminating sources of infection in the health care agency, home, or community.
26-3Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Pathogens, Infection, and Colonization
Pathogenicity is the ability of a microorganism to produce disease.
Microorganisms that cause diseases in humans are called pathogens.
Virulence is the degree of pathogenicity of an infection’s microorganism.
26-4Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Pathogens, Infection, and Colonization
Infection is an invasion and multiplication of microorganisms in body tissue that results in cellular injury.
These microorganisms are called infectious agents.
26-5Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Pathogens, Infection, and Colonization
Communicable Disease • The result of a communicable agent being
transmitted to a client by direct or indirect contact, through a vehicle (or vector) or airborne route
26-6Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Pathogens, Infection, and Colonization
Colonization is the multiplication of microorganisms on or within a host that does not result in cellular injury.
Flora are the vegetation of microorganisms on the human body.• Resident flora• Transient flora
26-7Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Agent, Host, and Environment
Agents capable of causing disease:• Biological agents• Chemical agents• Physical agents
26-8Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Agent, Host, and Environment
A host is a simple or complex organism that can be affected by an agent.• A susceptible host is a person who lacks
resistance to an agent.• A compromised host is a person whose
normal defense mechanisms are impaired and who is therefore susceptible to infection.
26-9Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Agent, Host and Environment
The environment consists of everything other than the agent and host.• Water, food, plants, animals• Housing conditions• Noise• Meteorological conditions• Environmental chemicals
26-10Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Chain of Infection
Microorganism (infectious agent) Source or reservoir Portal of exit from reservoir Mode of transmission Portal of entry into host Susceptible host
26-11Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Infectious Agents (Microorganisms)
Agents that produce infections can consist of bacteria, viruses, fungi, protozoa, and rickettsia
26-12Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Infectious Agents
The ability of a microorganism to infect a client is related to:• Virulence of the agent• Number of microorganisms present• Ability of the agent to enter and live in the
client• Susceptibility of the client
26-13Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Infectious Agents
Resident Infectious Agents • Microorganisms which are always present
on skin.• Can be reduced through handwashing, but
not totally removed.
26-14Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Infectious Agents
Transient Infectious Agents• Agents that are picked up by the skin from
another person or object.• Attach themselves to the skin and then may
be transmitted to a susceptible host.
26-15Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Source or Reservoir
Required for the microorganism to survive while awaiting a host.
May allow the organism to multiply, making it more dangerous.• The human body is the most common
reservoir.• Food, plants, animals, and feces are other
common reservoirs.
26-16Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Portal of Exit
Pathway by which pathogens leave the body of a host. Accessed by:• Direct Contact• Indirect Contact• Airborne Transmission
26-17Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Portal of Exit
Direct Contact• Transmission of disease from the host• Touching, kissing, and sexual intercourse
Sources of Direct Contact• Skin, mucus membranes, urine, feces,
reproductive tract, blood
26-18Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Portal of Exit
Indirect Contact • Occurs with the use of vehicles and vectors
Vehicles (fomites)• Toys, hospital supplies, instruments, dishes,
cups, or surgical dressings, food, fluids, blood
26-19Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Portal of Exit
Airborne Transmission• Transmission of infectious agents through
coughing, sneezing, dust particles• Usually entry via the person’s respiratory
tract
26-20Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Portal of Entry
Pathway by which infectious agents gain access to the body
26-21Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Susceptible Host
A person with a reduced immune response has increased susceptibility.
The immune response is the body’s natural defense against infection.
26-22Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Factors Influencing Production of an Infectious Disease
Age Heredity Stress Surgery Nutrition Health Status
26-23Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Factors Influencing Production of an Infectious Disease
Age• The elderly and children under two years of
age are at greatest risk.
Heredity• Conditions or diseases resulting in the
absence of or inability to form immune defenses.
26-24Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Factors Influencing Production of an Infectious Disease
Stress• Increase in metabolic rate which results in
using up stored energy• Elevation of blood cortisol, decreasing anti-
inflammatory responses• Continued stress produces exhaustion,
further depleting ability to ward off infection.
26-25Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Factors Influencing Production of an Infectious Disease
Surgery• Eliminates primary barrier of infection.• Predisposes clients to surgical site
infections.• Localized infection at wound site can
progress to a systemic infection.• Additional risks include catheters and tubes.
26-26Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Factors Influencing Production of an Infectious Disease
Nutrition• Insufficient protein consumption reduces
antibody production and inhibits the body’s ability to ward off infection.
Health Status• Clients with disease of their immune system
are at greater risk.• Chronic diseases can predispose the client
to infection.
26-27Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Normal Defense Mechanisms
Nonspecific and specific immune defenses work in harmony to defend the host from pathogens.
26-28Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Normal Defense Mechanisms
Nonspecific Immune Defenses• Protect the host from all microorganisms• Not dependent on prior exposure to the
antigen
26-29Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Nonspecific Immune Defenses
Skin and Normal Flora Mucous Membranes Sneeze, Cough Reflexes Tearing Reflexes Elimination Acidic Environment Inflammatory Response
26-30Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Nonspecific Immune Defenses
Skin• Intact skin is the body’s first line of defense
against infection.• Sebum is produced by the skin and contains
fatty acids that kill some bacteria.
26-31Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Nonspecific Immune Defenses
Normal Flora• Normal flora residing on the skin compete
with pathogenic flora for food and inhibit their multiplication.
• Inappropriate antibiotic use may disrupt the balance of normal flora.
26-32Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Nonspecific Immune Defenses
Mucous Membranes• Mucus entraps infectious agents and
contains substances that inhibit bacterial growth.
• Cilia trap and propel mucus and microorganisms away from the lungs.
26-33Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Nonspecific Immune Defenses
Sneeze and Cough Reflexes• Physically expel mucus and microorganisms
from the respiratory tract and oral cavity with force
Tearing Reflex• Protects the eyes by continually flushing
away microorganisms
26-34Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Nonspecific Immune Defenses
Elimination Patterns and Acidic Environment• Resident flora of the large intestines • Mechanical process of defecation• Flushing action of urination• Acidic environment of urine and vagina
26-35Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Nonspecific Immune Defenses
Inflammatory Response• Tissue injury caused by bacteria, trauma,
chemicals, heat, or any other phenomenon• Release of substances that produce
secondary changes in the tissue
26-36Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Specific Immune Defense (The Immune Responses)
Immunity is a specific defense mechanism that creates an immune response to a specific invading antigen.
26-37Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Specific Immune Defense (The Immune Responses)
Immune Responses• Active immunity• Passive immunity• Acquired immunity• Natural immunity• Artificial immunity
26-38Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Immune Responses
Active immunity results from the development within the body of antibodies that neutralize the infective agent.
Passive immunity is acquired by the introduction of preformed antibodies.
26-39Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Immune Responses
Acquired immunity results either from exposure to an antigen or from the passive injection of immunoglobulins.
Natural immunity refers to the genetically determined response of protection within a specific species.
Artificial immunity is produced following a vaccine.
26-40Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
The Humoral Immune Response
B lymphocytes recognize the antigen as an enemy.
Immunoglobulins are plasma protein cells that produce five different classes of antibodies (IgM, IgG, IgA, IgD, and IgE).
Immunoglobulins circulate throughout the bloodstream for the purpose of destroying antigens.
26-41Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Cell-Mediated Immunity
Fights pathogens that survive inside cells.
Antigen stimulates the release of activated T cells.• T-helper cells• T-suppressor cells• T-cytotoxic cells
26-42Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Localized Versus Systemic Infections
Infection results from tissue invasion and damage by an infectious agent.• Localized infections are limited to a defined
area or single organ.• Systemic infections affect the entire body
and involve multiple organs.
26-43Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Four Stages of Infection
Incubation Prodromal Illness Convalescence
26-44Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Nosocomial Infections
Infections acquired in a health care setting that were not present or incubating at the time of the client’s admission
26-45Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Common Sites of Nosocomial Infections
Urinary tract Surgical sites Respiratory tract
26-46Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Nosocomial Infections
Procedures identified as possible sources of infection are:• Inadequate handwashing • Catheterization technique• Improper suctioning technique• Improper dressing-change technique• Contamination of closed drain system
26-47Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Infection Chain
Breaking the chain of infection; preventive measures follow each critical link in the chain of infection.
26-48Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Asepsis
Asepsis is the absence of microorganisms.
Aseptic technique is the infection control practice used to prevent the transmission of pathogens.
26-49Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Medical Asepsis (Clean Technique)
Practices to reduce the number, growth, and spread of microorganisms• The most common cause of nosocomial
infections is contaminated hands of health care providers.
• Wash hands before and after every client contact.
26-50Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Surgical Asepsis (Sterile Technique)
Practices that eliminate all microorganisms and spores from an object or area• Surgical scrub• Surgical attire• Sterile fields• Sterile instruments and equipment
26-51Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Reduce or Eliminate Infectious Agents
Infection control practices to break the chain of infection • Cleansing• Disinfection • Sterilization
26-52Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Reduce or Eliminate Infectious Agents
Cleansing • Removal of soil or organic material from
instruments and equipment used in providing care
• Water, mechanical action, detergent
26-53Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Reduce or Eliminate Infectious Agents
Disinfection • Elimination of pathogens, except spores,
from inanimate objects • Use of germicides and antiseptics.
26-54Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Reduce or Eliminate Infectious Agents
Sterilization• Methods used for total elimination of all
microorganisms including spores are:- Moist heat or steam (autoclave, boiling water)- Radiation- Chemicals- Ethylene oxide gas
26-55Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Reduce or Eliminate Infectious Agents
Home Health Care Considerations• Adapting acute care infection control
practice to the home care setting involves:- Cleaning and disinfecting equipment- Using clean versus sterile technique- Handling of the nursing supply bag
26-56Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Reduce or Eliminate Infectious Agents
Disposal of Infectious Waste in the Home Biological Hazard Symbol OSHA Regulations
26-57Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Guidelines for Standards Precautions
Barrier Precautions• Use of masks, gowns, and gloves to
minimize the risk of exposure to blood and body fluids
26-58Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Guidelines for Standards Precautions
Body Substances• Blood• All body fluids • Secretions • Contaminated items regardless of whether
or not they contain visible blood• Nonintact skin• Mucous membranes
26-59Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Role of Health Care Personnel and Health Agencies in Infection Control
Mask and eye protection or face shield Non-sterile gown Tuberculosis masks Isolation precautions initiated when
positive cultures from a draining wound are reported
26-60Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Role of Health Care Personnel and Health Agencies in Infection Control
This nurse is interacting with a client who requires isolation precautions.
26-61Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Role of Health Care Personnel and Health Agencies in Infection Control
Reinforce adherence to isolation. Post signs indicating type of isolation. Provide necessary supplies. Place clients in a private room with
adequate ventilation. Use disposable supplies and equipment.
26-62Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Role of Health Care Personnel and Health Agencies in Infection Control
Labeling of all articles leaving the room Use of impermeable bags or double
bagging Client and family instruction Alert to psychological discomfort
26-63Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Role of Health Care Personnel and Health Agencies in Infection Control
Blood Borne Pathogen Exposure• OSHA requires that all health agencies
make available the hepatitis B vaccine and vaccination series to all employees.
26-64Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Role of Health Care Personnel and Health Agencies in Infection Control
Exposure Control Plan• Begins with standard precautions and
moves to postexposure prophylaxis• Specific follow-up for blood-borne pathogens• Postexposure prophylaxis only in cases of
highest risk
26-65Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Alternative Therapies Used to Treat Infections
Herbal Products• Antimicrobial action• Augment and vitalize the body’s own
defenses
Client’s alternative practices should be documented.
Possible adverse reactions are possible when used with prescribed drugs.