PCC week 1

Infection

Occurs when a pathogen invades the body, multiplies and causes disease, usually causing harm to the body.

Pathogen

A microorganism that causes a disease

Localized infection

Small area, redness, swelling, heat, pain. * can be normal such as redness from ear piercing or surgery

Disseminated infection

Infection that starts in one spot and spreads through the blood to other organs and areas of the body

Systemic infection

Illness that spreads through the bloodstream and affects the entire body rather than just a single organ or local area

• leukocytosis = high WBC…typically 11,000 and 25000 cells per

• Fever, increased heart rate and respiratory rate,

• Septic

Acute vs chronic infection

Acute = less than 6 months

Sources of infection

• hospital acquired

• Primary infection (skin- bacteria) vs secondary infection (take antibiotics and end up with a yeast infection)

Epidemiology

The study of how and why people are sick. Count cases, find patterns, search for causes, stop the spread

Incidence

The number of new cases of a disease in a specific population during a defined time period

Ex: look at new positive HIV cases in the past year

Prevalence

The total number of ppl who have a specific disease or condition in a population at a certain time.

What is the difference between incidence and prevalence?

Incidence measures the number of NEW cases

Prevalence measures the TOTAL number of cases

Endemic

Baseline level of disease in a particular area

Steady baseline rate within a region

Example:

Malaria= consistently present at predictable levels in parts of sub Saharan Africa and tropical regions.

Epidemic

Unexpected rapid increase in the number of disease cases in a specific geographical community or region.

Example: 2014 pertussis outbreak

Chain of infection

Pathogen

Susceptible host a person who is vulnerable to catching the disease because they lack immunity or resistance

Reservoir the place the pathogen lives, grows and multiplies

Portal of exit from reservoir: the way the pathogen leaves the reservoir such as coughing, sneezing open wounds

Mode of transmission: how the germ travels from the source to a new place or person via direct contact, droplets

Bacteria release ______ or ______, which damage the cells of the host and initiate an inflammatory response.

Endotoxins exotoxins

Categories of pathogens

Bacterial: strep

Viral: influenza, COVID, hep A and B, chicken pox, MMR, Polio, rabies

Fungi

Parasitic: 3rd world countries amoebas, flagellates

Prion: it causes encephalopathy issues example Creutzfeldt Jakob disease

Bacteria are classified on

Shape of the cell…cocci = strep

Bacteria reproduce after

Releasing their genetic material into cell of another living organism (once in body, the protein envelope makes it hard for us to cut it off)

Candida albicans is normal……but too much can cause…..

Mouth

Thrush

Fungal infections

Tinea pedis

Tinea corporis

Tinea pedia = athletes foot

Tinea corporis = ringworm

Protozoa lives

In soil and bodies of water

Not all prions cause disease but those that do often affect the

Nervous system

C-diff can be caused by

Antibodies that kill off normal flora and then c-diff bacteria takes over

Transmissible spongiform encephalopathy: creutzfeldt jakob disease, mad cow disease causes

Encephalopathy

Populations at greatest risk of infection

• lack of awareness

• Underinsured

• High cost of medications

• Inadequate nutrition

• No healthcare screenings

Infections: common diagnostic tests

Laboratory

Radiographic studies

Laboratory test for infection

CBC

Culture and sensitivity

C-reactive protein

ESR erythrocyte sedimentation rate

Serologic tests to detect specific antibodies or viruses

CBC w/ DIFF

DIFF adds a breakdown of the 5 WBC, to pinpoint specific infections.

Culture and sensitivity

Confirm the pathogen and sensitive to which medication.

C-reactive protein

Blood test marker for inflammation in body

Erythrocyte sedimentation rate

Blood test that measures how fast red blood cells sink to the bottom of a test tube in 1 hr.

Where there is inflammation in the body, certain proteins make red blood cells stick together in heavy clumps. The clumps sink faster

Serology test to

Detective specific antibodies or viruses

MRI for

Bone infection, soft tissues

CAT for

Tissues, internal organs

indium scans

Specialized nuclear medicine imaging tests to locate hidden infections areas of severe inflammation and cancers inside the body.

PET scans

Tracks how your body’s cells use energy and sugar.

Emerging infection

Infections that recently appear in population or known infections that are spreading rapidly into new areas.

Examples of emerging infections

Covid, sars, mpox, Ebola, west Nile virus

Reemerging infections

Infectious disease that was once under control or declining significantly but has returned or is growing rapidly in number or geographic spread

Example reemerging infections

Small pox, pertussis, measles, diphtheria

Zoonosis

Science of transmission of diseases from animal to humans

Examples of zoonosis

Rabies, Lyme, west Nile, SARS, flu, Ebola, coronaviruses

Why are there reemerging infections

Population density (college dorm)

Inadequate sanitation (3rd world)

Antibiotic misuse (ending too soon)

Bioterrorism

Low vaccine rates

International travel

How does bacteria become resistant

Germs develop the ability to defeat the drugs designed to kill them

How to treat resistant bacteria

No treatment sometimes

Alternative antibiotics (bad side effects)

VRE

Vancomycin

More virulent than MRSA

Survive on environmental surface for weeks

Anti microbial resistant infections; healthcare workers have contributed to the problem

• administering antibiotics for viral infections areas

• unnecessary antibiotic therapy

• Using inadequate drug regimes to treat infections

• Using broad spectrum or combo agents for infections that should be treated without first line medication

How patients have contributed to drug resistance

Skip doses

Stop antibiotic before full course is taken

Save and use antibiotics for later

Healthcare acquired infections

Acquired as a result of exposure to a microorganism in a health care setting

Number 1 way to prevent healthcare acquired infections

Wash hands

Healthcare acquired infections

Decreased rates with improved infection control measures

CLABSI - central line infection

CAUTI - catheter associated UTI

SSI - surgical infections

Infection: nursing interventions

Manage pain, fatigue and fever

Monitor fluid and electrolyte balance, nutrition

Administer anti microbials and IV fluids as ordered

Infection: primary prevention

Vaccines, hygiene (personal, food, hand)

Antimicrobial therapy

Lab testing helps determine the correct

Antibiotic

How an antibiotic kills bacteria

Bactericides agents: kill bacteria directly

Bacteriostatic agent: interfere with replication of bacteria

Before beginning antibiotic therapy

If ordered; start the antibiotic within an hour

Ask about any allergies

Set around the clock dosing schedules in order to maintain effective blood levels

Review all pts meds

Perform baseline and infection specific assessments

Ensure baseline lab tests are completed (LFTs)

What should the nurse do while pt is on antibiotic therapy for infections

• monitor for adverse effects, allergic reactions, superinfections

• Teach pt and family proper use of antibiotics

What is a superinfection

Can occur when antibiotics reduce or eliminate normal bacterial flora which allows other bacteria or fungi to take over and cause infection.

Classification of antibiotic agents

Penicillin

Cephalosporins (first, second, 3rd generation) generation has to do with what kind of bacteria they kill

Fluoroquinolones

Tetracyclines

Macrolides

Aminoglycosides

Antiviral therapy: available for only a small number of viral infections

Herpes, hepatitis, varicella, some influenzas

Most suppress viral replication

Geriatric infection rate is ___times higher

2-3

Geriatric common infections

Pneumonia, UTIs (catheters), skin infections, TB

Geriatric infection present atypically

Cognitive and behavioral changes precede fever, pain, lab value changes

Do not rely on the presence of fever in older adults

Geriatric pts have low temp

What is a retrovirus that causes immunosuppression

HIV

HIV perinatal transmission

Can occurs during pregnancy, delivery or breastfeeding

Treatment with ART can reduce rate of transmission to less than 1%

HIV is an RNA virus which means

Retrovirus replicates from RNA to DNA

HIV cannot replicate unless

It is inside a living cell

What is the target cell for HIV

CD4 +T cell is the target cell for HIV, it is a type of lymphocyte

HIV binds to ______ ________ on the outside of the cell through fusion

Protein receptors

Overtime HIV _____ more CD4 cells than the body can replace.

Destroys

Immune problems start when CD4+T cell count drop to less than ____

Less than 500 cells

Severe problems develop less than 200

What is the main cause of disease, disability and death in patients with HIV

Insufficient immune response allows for opportunistic diseases

HIV acute infection clinical manifestation and complications

• 2-4 weeks when newly infected ( most thing they just have a cold or virus)

• Fever, swollen lymph nodes, sore throat, headache, malaise, nausea, muscle pain

• May have neurological problems (peripheral neuropathy, facial palsy, guillain barre syndrome

• High viral load

• CD4 counts decrease temporarily, quickly return to baseline or near

• Can be asymptomatic up to 8 yrs

HIV turns to AIDS when

Dx 10 years if untreated

HIV symptomatic infection

CD4T cells decline 200

Symptoms worse

Persist fever, night sweats, chronic diarrhea, recurring headaches, severe fatigue

Thrush

AIDS criteria

Must have at least 1 of the following

• less than 200

• Opportunistic infections

• Opportunistic cancers

• Wasting sundrome

AIDS criteria opportunistic infection

Pneumonia, TB, CMV, toxoplasmosis, cryptococcal meningitis, mycobacterium avian complex

HIV diagnostic studies

Genotype assay: finds mutations of viral genes, helps Md pick the right drug

Phenotype assay: measures how well virus can reproduce when using an anti hiv drug

Safety alert: ARTs have interactions with

Herbal therapies; St. John’s wort

Antacids, proton pump inhibitors, supplements

HIV pre exposure prophylaxis

Reduce chances of acquiring HIV infections used in conjunction with other proven prevention interventions (condom, risk reduction, counseling, regular testing)

nPEP

Combo hiv art given within 72 hours after potential exposure and continues for 28 days

Unanticipated exposure sex, needle stick

Examples of contact precautions

MRSA in wound

C-diff have to wash hands

VRE

Gown, gloves

Examples of droplet

Influenza

Mumps