Infection

most common HAI

• UTI

• surg site infection

• pneumonia

how to help prevent HAI

• wash hands

• PPE

• isolate contagious pt’s

• proper cleaning & disinfecting of equipment

• keep vaccinations up to date

why is ER high risk for infection

close contact

define infection

• invasion of pathogens into the body that multiply and cause disease or illness

define virulence

ability of pathogens to cause severe disease

define communicability

ability of pathogens to spread from person to person and cause disease

Reservoir

• source of infectious agents

• ex.)

  • people

  • animals

  • soil

  • water

  • IV tubing

  • stethoscopes

susceptible host w/ portal of entry

• immunity protects us from illness and disease

• when our defenses weaken/break down, we get sick

route and method of transmission

ex.)

• resp tract

• gi tract

• gu

• Breaks in skin

• bloodstream

factors that increase risk for infection in the older pt

Decreased antibodies, lymphocytes, fever response, vascularity, wound healing, cough, gag reflexes, gastric acid, and mobility. More likely to have chronic illnesses like DM, COPD, and neurologic impairments. As well as incontinence, dementia, catheters, feeding tubes, trach tubes, IVs, and increased person-person contact.

contact transmission, PPE/room/travel, examples

most common, direct and indirect, skin to skin contact and mucous membrane contact: contaminated hands, equipment, environment

PPE/room/travel - private room or cohort with another with same active infection, gloves, wash hands before leaving, wear gown, only transport when needed and PT wears PPE, dedicated equipment or disinfect every time

Ex: Clostridium difficile, Colonization or infection caused by multidrug-resistant organisms (e.g., MRSA, VRE), Pediculosis, Scabies, and COVID-19 (possibly)

droplet precautions, PPE/room/travel, examples

large particles that fall to the ground, travel 3 ft, excreted by infected secretions, coughing, talking, sneezing

PPE/room/travel - private room or cohort with same active infection PT, but remain 3ft away from each other, mask when within 3-6 ft, transport with mask only when needed

Examples: Diphtheria (pharyngeal), Streptococcal pharyngitis, Pneumonia, Influenza, Rubella, Invasive disease (meningitis, pneumonia, sepsis) caused by Haemophilus influenzae type B or Neisseria meningitidis, Mumps, Pertussis, and COVID-19

airborne transmission, PPE/room/travel, examples

linger in air, smaller particles that travel 6ft, stay in air for mins-hrs

PPE/room/travel - private room with negative airflow, keep doors closed, N95 mask or PAPR/HEPA filter, only transport when needed and PT must wear a mask

Examples: measles/rubeola, varicella chickenpox, zoster/shingles, and COVID-19

Body tissues defense to infection

• intact skin (most important)

• mucous membranes (lysozymes)

• respiratory tract (filter, humidification, coughing)

• GI (gastric acid, peristalsis, digestive enzymes

• urinary tract (low pH)

phagocytosis as defense to infection

neutrophils engulf, ingest, and destroy invading organisms

inflammation as a defense to infection

inflammatory enzymes, histamine, and fibrinogen “wall off” damaged tissue area

immune system as a defense to infection

AMI & CMI processes

The nurse is assessing a client’s understanding about strategies to prevent infection. Which statement by the client indicates a need for further health teaching?

A. “I plan to wash my hands frequently and use sanitizer when I’m not near a sink.”

B. “Before flu season I plan to get a flu vaccine from my local pharmacy.”

C. “I will avoid large crowds and anyone whom I know has an infection.”

D. “I’m not going to worry about sanitizing surfaces because germs can’t live on them.”

“I’m not going to worry about sanitizing surfaces because germs can’t live on them.”

health promo and maintenance for infection

• *recognize high risk pt’s: immunosuppressants, young, old, diabetics, chronic lung diseases/COPD & teach them about prevention and treatment

• proper hand hygiene

• vulnerable populations (avoid crowds)

• immunizations

• sunscreen

• insect repellent

what is an endogenous infection

caused by the pt’s own flora

what is exogenous infection

• caused by an outside factor

• ex.) hands of HCW, tubes, implants

primary reason infection is transmitted to pt’s

poor hand hygiene in HCW

in what setting is infection control particularly difficult in

nursing home

methods of infection control & prevention

• hand hygiene

• disinfection/sterilizatiion

• standard precautions

  • PPE

  • PAPR - During aerosol-generating procedures on patients with suspected or proven infections transmitted by respiratory aerosols, wear a powered air-purifying respirator (PAPR) (most effective) or N95 mask in addition to gloves, gown, and face and eye protection.

• transmission based precautions

• staff & pt placement cohorting

• *****Protection of Visitors of Pts on T-BP’s: Hand hygiene, contact precaution, mask for droplet/airborne, and do not visit patients if you have an active cough or fever.

what is the precaution for visitors of pt’s on t-bps *

• use proper hand hygiene before and after pt visit

• wear gowns and gloves to prevent spread of drug resistant organisms

• wear a surgical mask if visiting a pt on droplet or airborne precautions

• do not visit pt’s if you have active cough or fever

• not enforced before covid

*What is biofilm (glycocalyx)

• complex group of microorganisms that function within the slimy gel coating on catheters, orthopedic implants/joint implants, enteral feeding tubes, plaque on your teeth, tonsils, and also in chronic wounds.

• become sources of infection that are resistant to antibiotics (may increase #) and disinfection

• DIFFICULT TO TREAT

what is MRSA

staph that doesnt respond to methicillin or other penicilin based drugs

ca-mrsa

• causes infections in healthy non-hospitalized people (community acquired)

• can cause serious skin and soft tissue infections, abscesses, boils, and blisters

what is delafloxacin?
specific administration concepts?

• first fluoriquinolone demostrated to be effective against MRSA

• available oral and IV but binds to other drugs

• oral admin

  • give 2 hrs before or 6 hrs after antacids and vitamin or mineral supplements

• IV admin

  • avoid administering with any solution containing metal cations (mg)

another drug that can treat MRSA

vancomycin (red man syndrome)

what is vre & cre

vancomycin resistant enterococcus
carbapenem-resistent enterobacteriaceae

who is at high risk for CRE

• critical care units

• nursing home

• pt who are immunosuppressed

• to prevent…

  • place high risk pt on contact precautions

  • chlorhexidine bath can help prevent or decrease colonization

to help prevent the transmission of a multidrug-resistant organism (MDRO) or other infection (ex covid)…

• wear scrubs and change clothes before leaving work

• keep work clothes separate from personal clothes

• take shower when you get home

what is fecal microbiota transport

• putting healthy flora into the lower GI system of a c-diff infected pt who doesn’t respond to antibiotic therapy

• feces of another person into C-Diff pt to help them grow normal flora

donors for fecal microbiota transport cant have

• hx of drug use

• chronic GI disorders

• recent exposure to pathogens

• hep a, b, or c

what is sepsis

systematic bloodstream infection

what happens in sepsis

death, organ failure, and DIC

what lab values will you see in a pt with sepsis

• lactate higher than 2

• decreases platelets (thrombocytopenia)

• increase in metabolism

• increases WBC (early)

• hypotension

• hyperglycemia

• crp

• esr

• culture and antibiotic sensitivity

what is crp

lab that checks for inflammatory processes

what is esr

• ethrocyte settlement rate

• shows inflammation in body but not where it is

s/s of sepsis

• fever

• changes in loc

• sweating and chills

• fast shallow breathing

• s/s of infection

• hyperglycemia

in sepsis, why might a WBC count decrease after being elevated initially

body cant fight off infection

what is I-PREPARE

• ask pt about particulate matter exposure (PME

  • Present work

  • Residence

  • Environmental concerns

  • Past work

  • Activities

  • referrals (and resources as needed)

  • Educate (how to lessen or prevent exposure)

what condition can accompany infection that the nurse should monitor for

dehydration (in the older adult)

before administering an antimicrobial drug…

• make sure pt is not allergic

• prevent life threatening reactions like anaphylaxis

Older adults taking antibiotics…

• tell them to drink additional fluid if diarrhea occurs

• monitor them closely for dehydration

  • acute confusion, hypotension, and tachycardia are common indicators of dehydration

hx to get from pt

• (tobacco, comorbidities, alcohol, exposed/travel?)

• exposure to any other infection (skin tear, fever, enlarged lymph nodes, sore throat, GI/respiratory/urinary issues)

how to manage fever in infection

Eliminate underlying cause of fever

Destroy causative microorganism

Drug therapy: Antimicrobials & Antipyretics

External cooling - Do not use fans that just blows the pathogens 

Fluid administration - TREAT fever: fluids **Observe for shivering

do pt need fluid if they have a fever

yes

expected outcomes for infection

• temp and vitals w in baseline

• no complications like dehydration or sepsis

• adherence to drug therapy regimen

older adult temp is

1-2 degree lower than normal in young adults

can have a fever at 99

s/s of dehydration r/t fever

• tachy

• confusion

• restlessness

Older adults with dehydration s/s

Acute confusion, hypotension, and tachycardia are common indicators of dehydration and require interventions such as IV fluids. Serum electrolyte levels may increase due to hemoconcentration, causing additional risks to the older adult.