fundamentals exam - Infection Prevention (5/5)

what is an infection?

a microorganism capable of causing diseases invades the body and multiplies

what are the types of pathogens?

bacteria

viruses

fungi

parasites

when does infection occur?

when pathogens overcome the body’s defenses

What are HAI’s?

healthcare associated infections (nosocomial)

longer the stay, the more risk

what’re common HAI’s?

central-line associated bloodstream infection (CLABSI)

catheter-associated urinary tract infection (CAUTI)

surgical site infection (SSI)

ventilator-associated pneumonia (VAP)

what are MDRO’s?

multi-drug resistant organisms

they are resistant to one or more antimicrobial therapies. difficult to treat with limited options

what is a common contributing factor to MDRO’s?

improper or excessive antibiotic use

what are common examples of MDRO’s?

MRSA

VRE

C. Diff

ESBL

what is the chain of infection?

infectious agent

reservoir

portal of exit

mode of transmission

portal of entry

susceptible host

describe infectious agent in the chain of infection

sometimes also known as causative agent or pathogen. bacteria, viruses, fungi, parasites

describe reservoir in terms of chain of infection

the habitat of the infectious agent. this can be a human/animal as well as other objects like contaminated soil, water, or food. even medical equipment.

describe portal of exit in terms of chain of infection

the route in which the pathogen leaves the reservoir.

respiratory tract, GI, skin, blood/body fluids, etc.

describe the mode of transmission in terms of the chain of infection

how the pathogen moves from place to place. some may be more than one route.

describe the portal of entry in terms of the chain of infection

any place that allows for the pathogen to enter a person. depending on the pathogen, it could be the same as the portal of exit.

describe susceptible host in terms of the chain of infection

required for pathogen to take hold and become a reservoir for the infection

what’re the different types of modes of transmission?

direct / indirect contact

droplet - droplets travel thru air and into mucosa

airborne - contaminated particles move into airspace of other person

what’re the protective mechanisms/barriers we have to combat infection?

the skin

respiratory tract

gastrointestinal tract

genitourinary tract

describe how the skin is a barrier

first line of defense, is dense with a low pH

not good if there is a break in skin

how is the respiratory tract a line of defense again infection?

humidification

mucous + cilia - trap and move pathogens

coughing / sneezing - expel pathogens

what is humidification in terms of respiratorry tract mechanisms against pathogens?

increases size of inhaled particles, making them more easily trapped

what is impaired protection of the respiratory tract?

those who suffer from chronic conditions have decreased protective functions. also those who smoke

how does the GI tract act as a defensive barrier to pathogens?

impaired protection?

acidity/mucous lining - creates hostile environment

chronic antiacid use

how is the genitourinary tract a defense mechanism against?

urines flow making it hard for microorganisms to adhere to epithelial lining and acidic nature of urine creates hostile environment

factors that increase the risk for infection include…

healthcare environment

not good hand ygiene

compromised health or bad defense against infction

poor personal hygiene

not good nutrition

living in crowded environment

poor lifestyle

over age 65

what’s a normal WBC?

5,000-10,000/mm³

what if WBC’s are higher or lower than normal range?

higher = maybe infection

lower = maybe immunosupression

what is a normal absolute neutrophil count (ANC)?

>1,500/mm³

what happens if ANC count is below 1000? 500?

patient considered neutropenic

risk of infection is very high

what are C-reactive protein(CRP) / Erythrocyte Sedimentation Rate (ESR)

nonspecific inflammatory markers of inflammation that can support our assessment

How can a chest x ray or MRI/CT help diagnostically?

chest x rays - can confirm pneumonia

CT/MRI - may help identify abscesses or deep-seated infections

common nursing diagnoses for infection?

1. risk for infection related to invasive devices or to impaired immune system

2. infection, acute

what’re other possible nursing diagnoses for infection?

impaired skin integrity

imbalanced nutrition: less than body requirements

what do we use for nursing care interventions to help stop the spread of infection?

PUUI

define the P in PUUI

Perform effective hand hygiene

define the first U in PUUI

use techniques or medical and/or surgical asepsis

define the second U in PUUI

utilize standard precautions

define the I in PUUI

implement transmission based precautions

utilized for clients with known or suspected infectious diseases that require additional infection prevention

what are other nursing care interventions?

apply infection control bundles

promote oral hygiee

encourage adequate fluid intake

support pulmonary hygiene

what are infection control bundles?

protocols and guidelines for how to provide care for clients in order to minimize their risk for an HAI

what is pulmonary hygiene?

turning and repositioning the patient, coughing and deep breathing, incentive spirometry.

stimulate ciliary movement and promote lung expansion

standard precautions for infection prevention

hand hygiene

PPE

cleaning of equipment

how long to wash your hands for? areas often missed?

15-30 seconds

b/t fingers, around thumb and wrist

guidelines for washing hands

clean before and after every client interaction. nails should be kept short

what are PPE’s

personal protective equipment used when caring for clients with transmittable infectious diseases of performing procedures that can expose us to blood/bodily fluids

gloves, gown, mask, googles, face shields

what’re transmission based precautions?

additional infection prevention measures that are put in place for patients who have or are suspected of having infectious diseases.

what’re the categories of transmission based precautions?

contact precautions

enteric precautions

droplet precautions

airborne precautions

combination precautions

protective precautions

what are contact precautions

gown and gloves prevent t transmission by way of direct or indirect contact

what are enteric precautions?

prevent transmission by way of direct or indirect contact with/ feces.

gown and gloves, bleach wipes for cleaning

what are droplet precautions?

prevent transmission of droplets by way of close contact (3 ft or less) with mucous membranes or respiratory secretions.

surgical mask

airborne precautions?

prevent transmission of very small microorganisms that remain suspended in the air

N95 mask or powered air purifying respirators (PAPR)

HEPA filtration of air from patients room

what’re combination precautions?

strict isolation. prevent transmission of microorganisms that can spread by multiple routes of transmission.

combo of contact w droplet/airborne precautions.

protective precautions?

unique. for clients who are at high risk of contracting an infection. wear gloves and a mask while inside room and client wears mask if exiting room.

medical asepsis

clean technique

decreases number of microorganisms

reduces risk of infection

surgical asepsis

sterile technique

eliminates all microorganisms

prevents surigical site infections (SSI’s)

what is sterile gloving?

used when sterile gloves are required for procedures at the bedside

must keep hands above waist level and in sight

skin to skin and glove to glove