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Infectious agents include...
Bacteria, virus, fungi, and parasites
What is bacteria?
-Many different types and can be categorized
-Most significant and most prevalent in hospital settings
What is a virus?
Smallest of all microorganisms
What is fungi?
Plant like organisms present in air, soil, and water
What are parasites?
Live on or in a host and rely on it for nourishment
How to classify bacteria?
Shape
-spherical (cocci)
-rod (bacilli)
-corkscrew (spirochetes)
Response to gram staining
-gram negative
-gram posiitve
Need for oxygen
-aerobic (needs oxygen to live)
-anaerobic
Factors affecting an organisms potential to produce disease?
Number of organisms, virulence, competency of persons immune system, length and intimacy of contact between person and microorganisms, colonization vs infection
What is the difference between colonization and infection?
Colonization: microorganisms enter someones body but are contained by the body immune system. No active signs or symptoms
Infection: microorganisms are not contained, body shows signs and symptoms
What is an endemic?
A disease or conditions regularly found among particular people or in a certain area or during a certain time
(ex. malaria in africa)
What is exogenous?
Microorganism comes from outside the body
What is a pandemic?
Global outbreaks of a new or not previously identified virus
What is endogenous?
From within the body
-Normal flora in body becomes abnormal OR normal flora from one part of body accidentaly moves to a different part of body that its not supposed to be in
Possible reservoirs for microorganisms?
Other people, animals, soil, food, water, milk, inanimate objects
Common portals of exit?
Respiratory, gastrointestinal, genitourinary tracts, breaks in skin, blood and tissue
Different means of transportation?
Direct contact
Indirect contact
-Vector (mosquito)
-Fomite (inanimate object)
Droplet
Airborne- tiny, suspended in air
What are the stages of infection?
Incubation period
Prodromal stage
Full stage of illness
Convalescent period
What is the incubation period?
1st stage of infection
-Organisms growing and multiplying
-Time organism first enters body until the very first vague sign or symptom
What is the prodromal stage?
2nd stage of infection
-Person is most infectious
-Vague and nonspecific signs of disease
What is the full stage of illness?
3rd stage of infection
-Presence of specific signs and symptoms of disease
What is the convalescent period?
4th stage of infection
-Recovery from the infection
What is the inflammatory response?
Helps the body neutralize, control, or eliminate the offending agent, and prepare the site for repair
-Occurs in response to infection or injury
-Can be acute or chronic
-Has two stages (vascular and cellular)
What is the first stage of the inflammatory response?
Vascular stage
-vasodilation increases blood flow (redness and heat)
-histamine release causes permeability of vessels and protein rich fluid to get to the site of injury (swelling, pain, loss of function)
What is the second stage of the inflammatory response?
Cellular stage
-leukocytes and neutrophils consume debris
-damaged cells are repaired
What is the difference between humoral and cell mediated immunity?
Humoral: creates antibodies
Cell mediated: increases lymphocytes that destroy or react with harmful cells in body
Factors affecting risk for infection?
-Intact skin and mucous membranes
-Normal pH levels
-Body's white blood cells
-Age, sex, and hereditary factors
-Fatigue, climate, nutritional and generational health status
-Stress
-Use of invasive or indwelling medical devices
What laboratory date can indicate an infection?
-Elevated white blood cell count
-Increase in specific types of white blood cells
-Elevated erythrocyte sedimentation rate (ESR)
-Presence of pathogen in urine, blood, sputum, or draining cultures
What is a normal WBC count?
5,000-10,000
What is asepsis?
Includes all activities to prevent infection or break the chain of infection
What is medical asepsis?
-Clean technique to reduce number of pathogens
-Hand hygiene and wearing gloves
What is surgical asepsis?
-Sterile technique to keep area free from microorganisms
-Usually done when inserting an indwelling urinary catheter or IV
Factors determining use of sterilization and disinfection methods?
Number/nature of organisms present, type of equipment, intended use of equipment, available means for sterilization and disinfection, time
Difference between transient and resident flora?
Transient: attached loosely on skin, removed with relative ease
Resident: found in creases in skin, requires friction with brush to remove
5 times you should perform hand hygiene?
-Before touching a patient
-Before a clean or aseptic procedure
-After a body fluid exposure risk
-After touching a patient
-After touching patient surroundings
When to wear gloves?
When in contact with blood/bodily fluids
When to wear a gown?
To protect uniform/skin
When to wear masks?
To protect against inhalation of microorganisms
When to wear protective eyewear?
When splashing could occur
What is donning?
Putting on PPE
What is doffing?
Removing PPE
What are standard precautions?
-Used in the care of ALL hospitalized patients regardless of their diagnosis or possible infection status
-Wear gloves when actual or potential exposure to blood, all body fluids, secretions, and excretions except sweat (whether or not blood is present or visible), nonintact skin, and mucous membranes
-New additions are respiratory hygiene/cough etiquette, safe injection practices, and directions to use a mask when performing high-risk prolonged procedures involving spinal canal punctures
What are transmission based precautions?
-Used IN ADDITION to standard precautions for patients in hospitals with SUSPECTED INFECTION with pathogens that can be transmitted by airborne, droplet, or contact routes.
-Don PPE when entering the room of a patient on transmission-based precautions, and remove only when leaving the room
Airborne infections for transmission based precautions?
-Include TB, chickenpox, & measles
-Keep patient in private room with negative pressure
-Wear N-95 mask when entering room
-Patient to wear surgical mask when out of room
Droplet infections for transmission based precautions?
-Include rubella, mumps, diptheria, adenovirus, & RSV
- Keep patient in private room
-Don PPE for contact with patient or environment
-Patient to wear surgical mask when out of room
Contact infections for transmission based precautions?
-Include GI viruses, MDRO's, skin infections
-Keep patient in private room
-Don PPE for contact with patient or environment
-Limit patient movement out of room
-Avoid sharing equipment with other patients
How to teach patient medical asepsis at home?
-Wash hands before preparing or eating food
-Prepare foods at high enough temperatures
-Wash hands, cutting boards, and utensils before and after handling raw poultry and meat
-Keep food refrigerated
-Wash raw fruits and vegetables
-Use pasteurized milk and fruit juices
-Wash hands after using bathroom
-Use individual care items rather than sharing
4 times to use soap and water and not hand gel
-When hands are visibly dirty/contaminated
-After using the restroom
-Before eating
-After handling raw meat or animal waste
What are the layers of the skin and what do they do?
Epidermis
-protective waterproof layer
-regenerates easily and quickly
Dermis
-contains nerves, hair follicles, glands, immune cells, and blood vessels
Subcutaneous
-anchors the skin layers to underlying tissues
Functions of the skin?
Protection
Body temperature regulation
Psychosocial (self esteem)
Sensation
Vitamin D production
Immunologic
Absorption
Elimination (sweating)
Resistance to injury is affected by...
Age, amount underlying tissues, and illness
Skin developmental considerations?
-In children younger than 2 years, the skin is thinner and weaker
-In elderly people, the skin becomes thin and easily damage, circulation and collagen formation re impaired, and sweat glands are less active.
Very ---- and very ---- people are more susceptible to skin injury
thin, obese
Different types of wounds?
-Intentional or unintentional
-Neuropathic or vascular
-Pressure related
-Open or closed
-Acute or chronic
-Partial thickness, full thickness, or complex
Difference between an intentional and unintentional wound?
Intentional wound: surgical, least likely to become infected
Unintentional wound: traumatic
Difference between a neuropathic and vascular wound?
Neuropathic wound: wound caused by nerve damaged
Vascular wound: wound caused by problems with the blood vessels
Difference between an open and closed wound?
Open wound: there is an opening in the epidermis
Closed wound: no opening in the epidermis, common sign is ecchymosis
Difference between an acute and chronic wound?
Acute wound: heals within days to weeks
Chronic wound: takes longer to heal, most likely stuck in inflammatory phase
Difference between partial thickness, full thickness, and complex wounds?
Partial thickness wound: goes through epidermis into dermis, does not go beyond dermis
Full thickness wound: goes through dermis into subcutaneous tissue and possible even beyond
Complex: involves complications (fistula, hemorrhage, undermining, tunneling)
Principles of wound healing?
-Intact skin is the first line of defense against microorganisms
-Careful hand hygiene is used in caring for a wound
-The body responds systemically to any of its parts
-An adequate blood supply is essential for normal body response to injury
-Normal healing is promoted when the wound is free of foreign material
-The extent of damage and the persons state of health affect wound healing
-Response to wound is more effective if proper nutrition is maintained
Phases of wound healing?
-Hemostasis
-Inflammatory
-Proliferation
-Maturation
What is hemostasis?
1st phase of wound healing
-occurs immediately after initial injury
-involved blood vessels constrict and blood clotting begins
-exudate is formed, causing swelling and pain
-increased perfusion results in heat and tenderness
-platelets stimulate other cells to migrate to the injury to participate in other phases of healing
-patient can NOT heal until bleeding has stopped
What is the inflammatory phase?
2nd phase of wound healing
-follows hemostasis and lasts about 2 to 3 days
-WBC's move to the wound
-macrophages enter the wound, they ingest debris and attract fibroblasts
-exudate is formed and accumulates, causing pain, redness, and swelling at injury
What is the proliferation phase?
3rd phase of wound healing
-lasts for several weeks
-granulation tissue is built to fill the wound space through the action of fibroblasts
-capillaries grow across the wound
-a thin layer of epithelial cells forms across the wound
What is granulation tissue?
-New tissue
-Formed in the proliferation phase
-Is a sign that healing has begun
-Beefy red color
-Forms a foundation for scar tissue development
What is the maturation phase?
4th and final phase of wound healing
-begins about 3 weeks after the injury, can continue for moths or years
-collagen is remodeled
-formation of scar
What is a scar and what is it caused by?
A flat, thin, white line; avascular collagen tissue that does not sweat, grow hair, or tan in sunlight
-caused by new collagen being deposited which compresses the blood vessels in the wound
Systemic factors affecting wound healing?
-Age (children and healthy adults heal more rapidly)
-Circulation and oxygenation
-Nutritional status
-Wound etiology (specific condition of the wound affects healing)
-Health status (corticosteroid drugs and postoperative radiation therapy delay healing)
-Immunosuppression
-Medication use
-Adherence to treatment plan
Local factors affecting wound healing?
-Pressure (if wound on butt, blood flow is compressed)
-Desiccation (dry wound bed)
-Maceration (wet wound bed)
-Trauma
-Edema
-Infection
-Excessive bleeding
-Necrosis (eschar)
-Presence of biofilm
What is desiccation?
Dehydration, drying out
What is maceration?
Overhydration
What is eschar?
Black dead tissue
-must be removed for healing to begin
What is biofilm?
Thin cloudy film that can cover the surface of wounds
Wound complications?
-Infection
-Hemorrhage
-Dehiscence and evisceration
-Fistula formation
What is the difference between dehiscence and evisceration?
Dehiscence: staples/sutures pop out, wound separates
Evisceration: organ is protruding outside of body, medical emergency
-Both are usually surgical/sutured wounds
-Both are treated by covering incision site with sterile saline soaked dressing
What is a fistula?
Infected fluid sitting outside of wound bed that causes damage of tissues and makes a tunnel, either to outside of the body or to another organ
Psychological effects of wounds?
Pain, anxiety, fear, impact on activities of daily living, change in body image
Where do ALL pressure ulcers happen?
Over a bony prominence
What is a stage 1 pressure injury?
-Nonblanchable erythema of intact skin
-Stays red when pressed down
-May appear differently on dark skin
What is a stage 2 pressure injury?
-Partial thickness loss of skin with exposed dermis
-May present as a blister
-The wound bed is viable, pink or red, & moist
What is a stage 3 pressure injury?
-Full thickness loss of skin
-Adipose tissue is visible
-May have undermining and tunneling
-Often has granulation tissue
What is a stage 4 pressure injury?
-Full thickness skin and tissue loss
-Past subcutaneous tissue
-Exposed or directly palpable muscle, tendon, or bone
-Slough and eschar may be visible
What is an unstageable pressure injury?
Slough or eschar obscures the extent of tissue loss
What is slough?
Stringy, yellow substance attached to wound bed
What is a deep tissue injury?
-Intact or non intact skin with areas of nonblanchable deep red, maroon, or purple discoloration
-May evolve to reveal pressure injury
What is the Braden score for prediction?
-Used on admission
-Predicts pressure sore risk
-Includes 6 categories (sensory perception, moisture, activity level, mobility, nutrition, friction/shear)
-23 is the highest score possible
-Score of 19-23 is not at risk
-9 or less is very high risk
What test can be done to see if patient is malnourished?
Protein test (albumin)
How to clean a pressure injury/wound?
-Use new gauze for each wipe and clean from top to bottom and/or from the center to the outside (clean area to dirty area)
-Use 0.9% normal saline solution to irrigate and clean the injury
-Once the wound is cleaned, dry the area using a gauze sponge in the same manner
-Report any drainage or necrotic tissue
-Clean with each dressing change
Purposes of wound dressings?
-Provide physical, psychological, and aesthetic comfort
-Prevent, eliminate, or control infection
-Absorb drainage
-Maintain moisture balance of the wound
-Protect the wound from further injury
-Protect the skin surrounding the wound
-Debride (remove damaged/necrotic tissue), if appropriate
-Stimulate and/or optimize the healing response
-Consider ease of use and cost-effectiveness
How to change a wound dressing?
-Prepare the patient
-Use appropriate aseptic techniques
-Hand hygiene before and after
-Adhere to standard and transmission-based precautions
-Remove the old dressing
-Cleanse the wound
-Apply a new dressing
-Secure the dressing
How and when to do a skin assessment?
-Inspect and palpate head to toe, including bony prominences
Do a skin assessment on admission and at regular intervals:
-Make sure there is NO skin break down on admission
-Acute care (hospitals) should assess every shift
-Long-term settings should assess weekly for 4 weeks then quarterly
-Home health care should assess each visit
Devices to apply heat?
-Hot water bags
-Electric heating pads
-Aquathermia pads
-Hot packs
-Warm, moist compress
-Sitz bath
-Warm soaks
Effects of applying heat?
-Dilates peripheral blood vessels
-Increases tissue metabolism
-Reduces blood viscosity and increases capillary permeability
-Reduces muscle tension
-Helps relieve pain
Devices to apply cold?
-Ice bags
-Cold packs
-Hypothermia blankets
-Cold compress
Effects of applying cold?
-Constricts peripheral blood flow
-Reduces muscle spasms
-Promotes comfort
Factors affecting the response the hot and cold treatments?
-Method and duration of application
-Degree of heat and cold applied
-Patient's age and physical condition
-Amount of body surface covered by the application
