INFECTION CONTROL AND ISOLATION

What is infection?

◦A disease state that results from the presence

of pathogens in or on the body.

What are agents that can cause an infection?

Bacteria, Viruses, and Fungi

Pseudomonas is

a bacterial infection

Depending on what is the deterrent of the disease is…

it will help you determine what kind of PPE that you’re going to end up using.

Depending on what grows out of some diagnostics tests from the patients sample…

it will also determine the type of PPE needed for safe handling and treatment.

What is a PPE?

Personal Protective Equipment used to protect healthcare workers from exposure to infectious agents. Only used for one use time and should be disposed of properly after use.

Do you need to have a doctor’s order to put a patient in and out of isolation?

Yes

If a patient has elevated WBCs,…

that might be an early indicator that the patient is infectious

What kind of diagnostics, or tests, could be used to help determine if a patient needs to be put in isolation?

Some common diagnostics include cultures, blood tests/cultures, urine tests, and wound tests that can identify infectious agents.

CDC

Center for Disease Control help prevent and control the spread of diseases through regulatory guidelines and recommendations.

OSHA

Occupational Safety and Health Administration, which ensures safe working conditions and sets standards to protect workers from health hazards.

Within the hospitals, there is generally an infection control nurse who…

manages the quality and control of the hospital. They usually are watching out for positive cultures.

What happens when somebody finds a positive culture?

People would notify the infection control nurse, and then that nurse will speak to other nurses, figure out the assessment, what kind of PPE and standard precautions are needed to put the patient in.

Infectious agents are…

pathogens such as bacteria, viruses, fungi, and parasites that can cause disease in a host.

Reservoirs are…

places where infectious agents live, grow, and multiply, such as humans, animals, and the environment. They can grow in living and nonliving places. (ex. soil, water, food sources)

What are some Portals of exit that pathogens from infections can be expelled from?

*Respiratory

*Gastrointestinal

*Genitourinary tracts

*Breaks in skin

*Blood & tissue

How is Respiratory a portal of exit?

It is a portal of exit as pathogens can be expelled through droplets when an infected person coughs, sneezes, or even talking.

How is Gastrointestinal a portal of exit?

It is a portal of exit as pathogens can be expelled through emesis (vomiting) and diarrhea.

How is Genitourinary tracts a portal of exit?

It is a portal of exit as pathogens can be expelled through urine or genital secretions.

What are modes of transmission?

Refer to the various ways pathogens can spread from one host to another, including direct contact, droplets, and airborne.

Example of an airborne illness

Measles is an example of an airborne illness that can be transmitted through respiratory droplets.

Airborne illnesses, like measles, can pass through masks…

You would need a N95 respirator and those patients that come in the hospital will be put in a specific are in the hospital to prevent any transmission.

What are some portals of entry?

◦Eye, nares, mouth, vagina, cuts, scrapes

◦Wounds, surgical sites, IV

or drainage tube sites

◦Bite from a vector

Who can be a susceptible host for infectious diseases?

Anyone with a weakened immune system, including the elderly, infants, and individuals with chronic illnesses.

How many WBC’s need to be an inadequate amount for a normal human?

Below 4,500 WBCs. Patients don't have enough white blood cells to protect them themselves from the infectious pathogens that nurses or family members or other visitors could bring into them. Cancer patients are an example of those who may have inadequate WBC levels due to their condition or treatment.

What are some alterations of the primary defense that can make you susceptible to infection?

Problems with your eyes, or any alteration in the tears. Non intact skin, normal flora has gone out of your GI.

Say you've had an illness and you've had nausea, vomiting, diarrhea, lots of diarrhea. You lose that normal flora in your gut. You may have gotten over the diarrhea part of it, but you're still susceptible to infectious agents.

What are some Primary defenses against infection?

*Intact skin

*Mucous membranes

*Tears

*Normal flora in gastrointestinal (GI) tract

*Normal flora in urinary tract

What are some Secondary defenses against infections?

• Inflammatory response

-localized inflammatory response, like swelling, warmth, hot, painful

-systemic inflammatory responses is body wide, high temperature, neurological changes, or sepsis.

-the elderly are very susceptible to systemic

• Immune response

What is a localized inflammatory responese?

Swelling, heat to the touch, hot, painful.

What are some tell tale signs of a localized inflammatory response on an infected incision?

swelling, warmth, hot, painful, drainage, or odor.

What is a systemic inflammatory response?

The body's widespread reaction to infection, characterized by high fever, increased heart rate, and changes in neurological status. Body wide, high temperature, neurological changes, or sepsis.

What are some factors that support the body’s defense against infection?

►Adequate nutrition

- proteins, healthy fats, hydration, fruits, and veggies

-cutting down on the processed or ultra processed foods

►To manufacture cells of the immune system

-nutrition helps with manufacturing new cells in our body and sleep helps restore balance.

►Balanced hygiene

-patients should be bathed every 1-2 days, but some hospitals might have a bathing schedule for patients

►Sufficient to decrease skin bacterial count

►Not overzealous; causes skin cracking

►Rest/Exercise

►Reducing Stress

►Immunization

How often should patients be bathed?

Every 1-2 days

Perineal cleaning, bathing, or cleansing is necessary for patients with…

Urinary catheters or general incontinence. Encourage handwashing of all patients.

What are some ways to reduce stress for your patient?

Encourage rest, encourage limitation of visitors. if you recognize that your patient is overstimulated with a lot of people in and out, in and out all the time. Encourage them to eat, encourage that good hygiene, encourage them to take their medications if they're kind of against that for now.

If your patient is in the elderly population, you may need to ask about these potential vaccinations:

pneumonia, shingles, and chicken pox. Ask questions like

"Have you had your pneumonia vaccine?" or "When was your last shingles shot?"

“Have you ever had chicken pox in the past?” or

“Have you had your flu shot for this year?”

What is neuropathy?

Neuropathy is a condition characterized by damage to the peripheral nerves, which can cause pain, weakness, and numbness, often in the hands and feet. It may result from various factors including diabetes, infections, and trauma.

How do you control neuropathy?

It is a permanent condition, so management focuses on alleviating symptoms and improving quality of life through compliance medications, like good blood sugar control, physical therapy, and lifestyle changes.

Smoking can…

constrict perfusion and blood flow to peripheral nerves, worsening neuropathy.

Injured smokers can…

have perfusion issues in their extremities due to compromised blood flow and increased risk of complications. Due to this, they may experience delayed healing in those extremities because there is no blood flow to heal them.

Recipients of transplants are on medications that keep the immune response down because…

they need to be in that state so their body won’t reject the transplant.

Cancer patients and transplant recipients with low white blood cell counts are put in…

reverse isolation to protect them from infections. All visitors must be decked out in PPE because their immune systems are compromised and no living things can be brought in, like plants

Incubation is from the time of infection until the manifestation of symptoms. Example?

From the time you get exposed till the time you have a runny nose. That's your incubation time frame.

The prodromal is the appearance of vague symptoms you may experience…

like a mild throat irritation but this is your most infectious stage, your prodromal is before more severe symptoms develop. It can last several hours to several days.

The full stage of illness is…

signs and symptoms that are fully present.

If the patient's immune defenses and medical treatments are ineffective,…

this Full Stage of Illness can lead towards that septic stage, which, if left untreated, can lead to death.

In a convalescent period, the body starts to repair itself and repair tissues. How long does this period last?

It can last for several days to months, depending on the severity of the illness.

Systemic

►Spread via blood or lymph

►Affects many regions/throughout the

body

The systemic moving on includes fever, chills, high WBC counts, high white blood cell counts, malaise, anorexia, and generalized weakness.

Lymph node enlargement may be another sign of a…

systemic infection, left untreated it can move into organ failure and then resulting in death.

During this time frame of systemic infection, your patients are generally febrile with higher temperatures, which increases metabolism, so it depletes the body of fluids…

So your patients are going to be dehydrated, which will also result in a decrease in a blood pressure.

What are the four pieces of a CBC that I want to look at as a nurse?

The four components of a Complete Blood Count (CBC) to monitor are hemoglobin, hematocrit, white blood cell (WBC) count, and platelet count.

What do the four components of the CBC tell me?

Are they infectious? Do they have good volume? Do they have good blood carrying oxygen cells? And then platelets. What does platelets tell me? Do they have a clotting ability?

What do you need to know before giving a patient Lovinox?

You have to have the platelet count before you give the injection.

What is a normal WBC?

A normal white blood cell (WBC) count typically ranges from 4,500 to 11,000 cells per microliter of blood, indicating the body’s immune status.

What is an ESR?

Erythrocyte sedimentation rate (ESR) measures how quickly red blood cells settle at the bottom of a test tube in a period of one hour, indicating inflammation in the body. Normally your RBCs will settle fairly slowly, but with inflammation it settles very fast resulting in a higher ESR.

What is a normal ESR?

0-20mm/h. Anything higher than 20 is elevated.

A culture is…

a laboratory test that detects the presence of pathogens, like bacteria, viruses, or fungi in a sample from the body, such as blood or urine.

How long does it take for the nurse to get a culture back?

Usually 24 to 48 hours for preliminary results, but it could get up to 72 hours.

Why would a culture need to get down to a lab fast?

To ensure timely detection and treatment of infections, as delays can lead to complications or worsening of the patient's condition. HCPs need the results of the culture to see what antibiotics the pathogen is susceptible to, allowing for appropriate treatment to begin.

Until culture reports come back, what do HCP put their patients on?

broad-spectrum antibiotics are prescribed as a precaution. It can cover both susceptible and resistant pathogens while waiting for specific results.

What is an epidemic?

outbreak of a disease that suddenly affects a large group of people in a geographical region. Ex. measles, ebola

What is a pandemic?

an exceptionally wide spread epidemic.

What are HAIs?

Healthcare-associated infections that occur when healthcare staff cause it. They can arise from various sources, such as contaminated instruments or surfaces, and affect patients during their healthcare treatment.

What is a CAUTI?

Catheter-associated urinary tract infection, typically occurring in patients with urinary catheters. They are the most common type of healthcare-associated infection and can lead to serious complications.

What are SSIs?

Surgical site infections that occur a lot of times in actual surgical procedure in the OR with the physician and the nurses and the team that was in there so actually infected and at during the surgery time frame.

What are CLABSI?

Central line-associated bloodstream infections that occur when bacteria enter the bloodstream through a central line. They can lead to severe complications and are preventable with proper sterile techniques.

What is MRSA?

Methicillin-resistant Staphylococcus aureus, a infection that is mostly in wounds, but it can be in urinary tracts. It's resistant to many antibiotics and can cause severe infections.

What is a C-diff infection?

A Clostridium difficile infection in the GI system caused by the bacteria that can lead to severe diarrhea and colitis, often following antibiotic use.

Why should you wash your hands with soap and water and not just use hand sanitizer after interacting with a patient with C-diff?

C-diff pathogen has like a hard outer shell and the only way to destroy it is with friction. Washing hands with soap and water effectively removes the spores of C-diff, whereas hand sanitizer may not be effective due to the spores' resistance.

Nursing History ( Using a clinical judgement model

►Review patient chart

►Patient interview

►Current medications & therapeutic measures

►Nutritional status

►History of immunizations

What are some questions to ask during the patient interview and why do we need to let the patient know why we are asking these questions?

Have you been sick? Have you had fever? Do you have any red areas on your body? Have you had any cuts, bruises, or wounds?

Let the patient know we're just trying to assess to see are if they are vulnerable to infection in some ways and try to figure out some ways that we can prevent the patient from being infected.

What are some questions we can ask about a patient's current medications and therapeutic measures?

We can ask about the names of their medications, dosages, how often they take them, and if they have experienced any side effects. This information helps us understand the patient's treatment regimen and any potential interactions or complications that might arise.

Ex. Are they at fall risk? Have they fallen lately? Do they have any injuries that we need to look at and see if there's any problems there?

What are some questions a nurse can ask the patient to find out their nutritional status?

What kind of foods do you eat? How often do you eat? Do you have someone who prepares for you? Or do you eat out all the time?

What are some cues to recognize? (Recognize Cues)

-ASSESSMENT OF SKIN INTEGRITY

-PRESENCE OF MEDICAL/THERAPEUTIC DEVICES

-SIGNS AND SYMPTOMS OF LOCAL OR SYSTEMIC INFECTION

-LABORATORY DATA

What are some cues to analyze? (Analyze Cues)

-RISK FOR INFECTION

-NUTRITIONAL STATUS

-KNOWLEDGE DEFICIT

-Ex. “I take something for my diabetes, but I don't really know what it is.”

-IMPAIRED SKIN/TISSUE INTEGRITY

-SOCIAL ISOLATION

-Ex. “Am I the problem? I'm infectious. No one wants to be in here with me because they're in and out and they don't spend any time with me.”

How do we generate solutions?

-Set goals and outcomes

-Prevention is key

-Control or reduce the extent of infection

-Maintain resistance to infection

-Involve the family

-Set priorities

-Collaborate with health care team

How do we Take Action against infections as a nurse?

►Hand hygiene

►Medical Asepsis

►Educate on health promotion

►Implement bundles with Health care-acquired

infections (HAIs)

►Practice preventive care- Standard and

Transmission precautions

How do we implement bundles with HAIs?

If a patient acquires an infection in the hospital from something we did, there are certain bundles of activities that the hospital sets in place.

Ex. Draw blood out of this central line IV one time a day, hand washing, ppe, there's infection control. We're gonna draw cultures every other day.

So it's lot of set of orders and call it a bundle because it's literally a bundle of stuff that they have to do.

Another thing about patients with healthcare associated infections is that the…

hospital cannot charge the patient for the care. So all medications, all treatment plans, all for the duration of that hospitalization. Anything that's related to the care of that infection, the hospital eats the cost and that’s how the government takes care of it.

How do we Evaluate Outcomes?

-Did the patient achieve the goals in their plan of care?

-What was effective in helping them reach those goals?

-What was ineffective?

-What would you change or do differently to help patients reach their goals?

What is the difference between Medical Asepsis and Surgical Asepsis?

Medical asepsis refers to practices that reduce the number of microorganisms, while surgical asepsis involves techniques to eliminate all microorganisms before an invasive procedure to prevent infection.

Medical Asepsis is referred to as “clean technique” because…

It reduces your pathogens and is used when you administer medications. It's also used when you give enemas, tube feedings, daily hygiene, you're bathing your patient.

Surgical Asepsis is referred to as “Sterile technique” because…

It eliminates all pathogens,t o prevent any possible infection. It’s used in some dressing changes, catheterization, and surgical procedures.

Five Moments for Hand Hygiene (WHO) World Health Organization, actually identify moments in which we touch patients or moments to actually maybe consider using PPE or wearing gloves.

◦Moment 1 – Before touching a patient

◦Moment 2 – Before a clean or aseptic procedure

◦Moment 3 – After a body fluid exposure risk

◦Moment 4 – After touching a patient

◦Moment 5 – After touching patient surroundings

What is MDRO?

Microorganisms that are resistant to one or more classes of antimicrobials that were originally used to treat those infections (WHO, 2020) These are organisms that are resistant to almost everything that's out there on the market.

You see this a lot sometimes in your elderly patients who have had high exposure to multiple types of antibiotics over the years and now they've got this super infection, that nothing will be able to treat it.

What are some MDRO?

❑ Methicillin-Resistant Staphylococcus aureus (MRSA)

❑ Vancomycin-Resistant Enterococci (VRE)

❑ Clostridium difficile (C-diff)

❑ Carbapenem-Resistant Enterobacteriaceae (CRE)

Standard Precautions:

These precautions are used in the care of all hospitalized clients and apply to:

✔ Protects healthcare workers from exposure

✔ Decreases transmission of pathogens

✔ Protects clients from pathogens carried by healthcare workers

• BLOOD

• BODY FLUIDS

• SECRETIONS

• NON-INTACT SKIN

• MUCOUS MEMBRANES

Contact Precautions are used for patients who has a pathogen that is sprayed by direct contact.

◦Pathogen is spread by direct contact

◦ Skin-to-skin, draining wounds, secretions, contaminated objects

◦Examples:

◦- Multidrug-resistant organisms (MRSA, C-Diff, etc.) Wound infections Herpes simplex

Isolation Precautions For Contact Precautions

◦Nurse to wear gloves and gown

◦Private room

◦Single-use stethoscope, designated blood pressure cuff, and

thermometer

◦Signage on door

Droplet Precautions

Pathogen is spread via large-particle droplets

◦Coughing, sneezing, touching contaminated objects.

◦Examples:

- Influenza

- Mumps

- Respiratory diseases (RSV, etc.)

Isolation precautions for Droplet Precautions

▪Nurse wears a surgical mask in the room

▪Patient wears a surgical mask when leaving room

▪Private room is preferred

▪Single-use stethoscope, dedicated blood pressure cuff, and

thermometer

▪Signage on door

Airborne Precautions

◦Pathogen is spread via small particles in the air

◦Ventilation systems, shaking sheets, sweeping

◦Examples:

◦Tuberculosis (TB)

◦Varicella zoster (chicken pox)

◦Measles

◦SARS

Isolation precautions for Airborne Precautions

◦Wear N-95 respirator mask (staff and visitors)

◦Use negative pressure room

◦Avoid transferring client if possible – patient must wear mask if transported

◦Single client use stethoscope, dedicated blood pressure cuff, and

thermometer

◦Signage on door