NURS 208: TOPIC 3 - INFECTION AND WOUNDS

What is an infection?

A disease state that results from the presence of pathogens in or on the body

What cyclic process leads to infection?

The infection process consists of 6 components: infectious agent, reservoir, portal of exit, means of transmission, portal of entry, and susceptible host

What is an infectious agent?

Bacteria, virus, or fungi that cause infection

What is a reservoir in the infection cycle?

The natural habitat of the organism, such as humans, animals, or the environment

What is the portal of exit in the infection cycle?

The point of escape for the pathogen from the reservoir

What are the means of transmission in the infection cycle?

Direct contact, indirect contact, airborne transmission, or droplet spread

What is the portal of entry in the infection cycle?

The point where the pathogen enters a new host, such as through mucous membranes or the respiratory tract

What is a susceptible host?

An individual who must overcome resistance to the pathogen due to weakened or insufficient defenses

What are the most significant and prevalent infectious agents in hospital settings?

Bacteria

What is the smallest of all microorganisms?

Viruses

What type of infectious agents are plant-like organisms found in air, soil, and water?

Fungi

Which infectious agents live on or in a host and rely on it for nourishment?

Parasites

What factor affects an organism’s potential to produce disease related to the amount of microorganisms present?

The number of organisms

What does virulence refer to?

How strong the organism is in causing infection

How does a person’s immune system competence affect their susceptibility to disease?

If a person is immunocompromised (such as cancer patients or those with autoimmune diseases like lupus), they are more susceptible to infection

Which factor involves how long and how close a person is in contact with a microorganism?

The length and intimacy of contact between the person and the microorganism

What is an example of a disease influenced by the length and intimacy of contact?

C. diff infection

What microorganism reservoir includes humans?

Other people

What microorganism reservoir includes animals and can cause ringworm?

Animals

What microorganism reservoir is linked to tetanus?

Soil

What microorganism reservoir can cause food poisoning?

Contaminated food, water, and milk

What microorganism reservoir is nonliving?

Inanimate objects

What is a common portal of exit involving sneezing and coughing?

Respiratory tract

What is a common portal of exit involving vomiting and diarrhea?

Gastrointestinal tract

What portal of exit involves urine and reproductive secretions?

Genitourinary tract

What portal of exit occurs through pressure ulcers or wounds?

Breaks in the skin

What portal of exit involves injuries or invasive procedures that release body fluids?

Blood and tissue

What is direct contact transmission?

Close range with an organism, such as in STIs

What is indirect contact transmission?

Transmission through a vector or fomite

What is a vector in indirect contact transmission?

A living organism that carries and spreads infectious agents

What is a fomite in indirect contact transmission?

An inanimate object that carries infectious agents

What are examples of fomites?

Bed rails, vital sign machines, IV pump, bedside table

What is droplet transmission?

Close range spray of droplets

What is airborne transmission?

Inhalation of droplets

What happens during the incubation stage of infection?

An infection enters the host and begins to multiply; no signs or symptoms are present, but the person is still contagious. Example: exposure to flu.

Is a person contagious during the incubation stage?

Yes, even though no signs or symptoms are present.

What are the symptoms during the prodromal stage of infection?

Non-specific symptoms such as fatigue, low-grade fever, and general malaise.

During which stage is the individual most contagious?

The prodromal stage.

What characterizes the acute illness stage of infection?

Full-blown signs and symptoms specific to the illness, peak severity, and the nurse focuses on symptom management.

• Example: flu patient with high fever, cough, body aches, and fatigue.

What happens during the decline stage of infection?

Manifestations begin to wane, the body starts to overcome the infection with or without medical intervention, symptoms subside, and the number of pathogens decreases.

• Example: flu patient’s cough stops, no fever.

What occurs during the convalescence stage of infection?

The client returns to a normal or a “new normal” state of health.

What is a local infection?

An infection that is confined to one area of the body and can be treated with topical or oral antibiotics.

What are examples of local infections?

Examples include urinary tract infections (that stay in the bladder) and ear infections.

What are common signs of a local infection?

Redness, swelling, and drainage at the site of infection.

What is a systemic infection?

An infection that starts as a local infection and then spreads to the bloodstream, affecting the entire body.

What are symptoms of a systemic infection?

Fever, chills, fatigue, and body aches.

What are severe symptoms of a systemic infection?

Low blood pressure, high heart rate, and organ dysfunction.

What is sepsis?

Sepsis is a severe systemic infection where the body’s response to infection causes widespread inflammation and organ dysfunction.

What is the inflammatory response?

A protective mechanism that always occurs when infection is present.

What is the goal of the inflammatory response?

Its goal is to help the body neutralize, control, or eliminate the offending agent and prepare the site for repair.

When does the inflammatory response occur?

In response to infection or injury.

What are the two types of inflammatory response?

It can be acute or chronic.

What happens during the vascular phase of inflammation?

Vasodilation increases blood flow to the injured area, causing redness and heat.

• Histamine release makes vessels more permeable, allowing protein-rich fluid to reach the injury site, resulting in swelling, pain, and loss of function.

What happens during the cellular stage of inflammation?

Leukocytes, mainly neutrophils, consume debris through phagocytosis, and damaged cells are repaired.

What are the signs of inflammation?

Pain, swelling, redness, heat, decreased function of the affected part.

What is nonspecific (innate) immunity?

Immunity you are born with that provides general protection against pathogens without memory of past infections.

What are the physical barriers of nonspecific immunity?

Skin and mucous membranes.

What are the chemical barriers of nonspecific immunity?

Stomach acid and tears.

Does nonspecific immunity have memory of past infections?

No, it does not.

Which cells are involved in nonspecific immunity as phagocytes?

Neutrophils and macrophages.

What is the role of phagocytes in nonspecific immunity?

They eat and destroy microorganisms, protecting the body from harm.

When are neutrophils and macrophages released?

During the inflammatory response.

What is specific (adaptive) immunity and how does it develop?

Develops with vaccines and all infections, both past and present.

What does specific immunity involve?

Specific immunity involves antibodies (immunoglobulins) and lymphocytes.

• Antibodies bind to infectious agents and signal white blood cells and complement to destroy them.

What is humoral immunity?

The aspect of specific immunity involving antibodies that target antigens in body fluids.

What is an antigen?

A foreign material, such as bacteria, that triggers an immune response.

What is an antibody?

A protein produced by the body in response to an antigen.

Give an example of humoral immunity in action.

A flu shot stimulates humoral immunity by prompting the body to produce antibodies against the flu virus.

What is cell-mediated immunity?

Involves an increase in lymphocytes that destroy or react with cells recognized by the body as harmful.

What are the factors that affect a person’s risk for infection?

Intact skin and mucous membranes, normal pH levels, white blood cells, age, sex, hereditary factors, immunization (natural or acquired), fatigue, climate, nutritional and general health status, stress, and use of invasive or indwelling medical devices.

How do white blood cells (WBCs) relate to infection?

They help fight infection; an increase in WBCs often indicates the presence of an infection.

How do invasive or indwelling medical devices affect infection risk?

They can introduce pathogens into the body, increasing the risk of infection; an example is a Foley catheter.

What is asepsis?

All activities to prevent infection or break the chain of infection.

What is medical asepsis?

Also known as standard precautions, it is a clean technique used to reduce the number of pathogens.

What are examples of medical asepsis practices?

Hand hygiene and wearing gloves.

What is surgical asepsis?

A sterile technique used to keep an area free from microorganisms.

When is surgical asepsis used?

During invasive procedures, such as inserting an indwelling urinary catheter or IV.

What types of procedures does surgical asepsis include?

Most invasive procedures.

What are the Five Moments for Hand Hygiene according to WHO?

Before touching a patient, before a clean or aseptic procedure, after a body fluid exposure risk, after touching a patient, after touching patient’s surroundings.

When should you use soap and water instead of hand sanitizer?

When hands are visibly soiled or after contact with body fluids.

Which HAI is transmitted via direct contact and can occur due to antibiotic overuse?

HAIs in general can be transmitted via direct contact and may result from antibiotic overuse.

What is a catheter-associated urinary tract infection (CAUTI)?

An infection caused when a Foley catheter is contaminated, mostly due to human error.

What is a surgical site infection (SSI)?

An infection that occurs at the site of a surgical incision.

What is a central-line–associated bloodstream infection (CLABSI)?

A bloodstream infection that occurs when bacteria or viruses enter the body through a central line.

What are invasive health care–associated and hospital-onset MRSA infections?

Infections caused by methicillin-resistant Staphylococcus aureus that are acquired in healthcare settings.

What are Clostridium difficile (C. diff) infections (CDIs) and CDI hospitalizations?

Infections caused by C. difficile bacteria, often after antibiotic use, leading to diarrhea and other complications, sometimes requiring hospitalization.

What are multidrug-resistant organisms known for?

They are easily transmitted.

What are some examples of multidrug-resistant organisms?

• Methicillin-Resistant Staphylococcus aureus (MRSA)

• Vancomycin (strong antibiotic) Intermediate-Resistant

• Staphylococcus aureus (VISA)

• Vancomycin-Resistant Staphylococcus aureus (VRSA)

• Vancomycin-Resistant Enterococci (VRE)

• Carbapenem (antibiotic)-Resistant Enterobacteriaceae (CRE)

• Acinetobacter Baumannii (CRAB)

• Clostridium Difficile (CDI)

What are the main types of personal protective equipment (PPE) and supplies?

Gloves, gowns, masks, protective eyewear.

What are Standard Precautions used for in healthcare?

They are used in the care of all hospitalized patients regardless of their diagnosis or possible infection status.

To which substances do Standard Precautions apply?

They apply to blood, all body fluids, secretions, and excretions except sweat (whether or not blood is present or visible), nonintact skin, and mucous membranes.

What are some new additions to Standard Precautions?

Respiratory hygiene/cough etiquette, safe injection practices, and directions to use a mask when performing high-risk prolonged procedures involving spinal canal punctures.

What PPE is required under Standard Precautions?

Gloves

What are transmission-based precautions used for in hospitals?

They are used in addition to standard precautions for patients suspected of infection with pathogens transmitted via airborne, droplet, or contact routes.

According to the 2007 guidelines, when should personal protective equipment (PPE) be donned and removed for patients on transmission-based precautions?

PPE should be donned when entering the patient’s room and removed only when leaving the room.

How many types of transmission-based precautions exist, and can they be used together?

Three types exist—airborne, droplet, and contact—and they may be used alone or in combination.

What is an example of an airborne infection, and what precautions are required?

Examples include tuberculosis (TB), Varicella (chickenpox), and Rubeola (measles).

• Precautions include a negative-pressure room with the door shut at all times, N95 mask, mask, goggles, gown, and gloves.

What is an example of a droplet infection, and what precautions are required?

Examples include pneumonia, rubella, and mumps.

• Precautions include gown, gloves, and goggles.

What is an example of a contact infection, and what precautions are required?

Example: Clostridium difficile.

• Precautions include gown and gloves.

What is tissue integrity?

Tissue integrity is the ability of the human body to regenerate and maintain normal physiologic functioning.