Protection: Infection and Inflammation

PROTECTION, INFECTION AND INFLAMMATION - Nursing 134

Learning Outcomes

  • Explain key terms in the textbook reading assignment.

  • Examine the infection cycle and evaluate methods to break the chain of infection.

  • Differentiate the stages and characteristics of infection.

  • Discuss nosocomial infections (Health Care Acquired Infections) and the sites they usually occur.

  • Identify factors that reduce the incidence of Health Care Acquired Infections.

  • Integrate standard precautions during patient care.

  • Differentiate the classifications of pathogens.

  • Explain the body’s normal defense against infection and identify patients at risk for developing infections.

  • Explain the inflammatory response, including signs and symptoms.

  • Utilize the nursing process to assist in the development of a plan of care/concept map for the care of patients with infection and inflammation problems.

  • Apply transmission-based precautions.

  • Utilize criteria to evaluate patients’ response to nursing interventions.

  • Evaluate the phases of wound healing and the types of repair.

  • Differentiate the roles of the RN and the LPN in the care of patients with infection and inflammation problems.

Infection Cycle and Methods to Break the Chain of Infection

  • Components of the chain of infection:

    • Infectious Agent (e.g., bacteria, viruses, fungi, parasites)

    • Reservoir (where pathogens live)

    • Portal of Exit (path the infectious agent takes to leave the reservoir)

    • Means of Transmission (how pathogens are spread)

    • Portal of Entry (how pathogens enter a new host)

    • Susceptible Host (individuals at risk for infection)

  • Methods to break the chain:

    • Immunizations

    • Screen healthcare staff

    • Hand hygiene

    • Sterilization and disinfection of equipment

    • Use of antibiotics/antimicrobials

    • Proper disposal of needles/sharps

    • Wearing gloves and masks

    • Adequate refrigeration to prevent pathogen growth

    • Use of pesticides to eliminate vectors

Infectious Agent Classifications

  • Bacteria: Most significant and common infection-causing agents in hospital settings.

    • Can multiply rapidly in a host.

  • Virus: The smallest of all microorganisms.

    • Requires a living host to replicate.

  • Fungi: Plant-like organisms, found in air, soil, and water.

  • Parasites: Organisms that live on or in a host and rely on the host for nourishment.

Factors Influencing Disease Production

  • Number of organisms: Higher quantities increase risk of infection.

  • Virulence: The ability of an organism to cause disease.

  • Immune system: Strength of the host's immune response affects likelihood of infection.

  • Length and type of contact: Prolonged contact with infected surfaces can lead to infection.

  • Colonization vs. Infection:

    • Example: E. coli can be a normal flora but can cause infection under certain conditions.

    • Clostridium difficile (C. diff) infections often arise after antibiotic disruption of normal flora.

Reservoirs of Infection

  • People: Most common reservoirs.

  • Animals: Can transmit zoonotic infections.

  • Fruit/Vegetables: Contamination can occur.

  • Fingernails & Inanimate objects: Can harbor pathogens.

Common Portals of Exit from Reservoirs

  • Respiratory tracts: Through coughing or sneezing.

  • Gastrointestinal tract: Fecal matter can spread pathogens.

  • Genitourinary tracts: Urine may carry infectious agents.

  • Skin breaks: Open wounds can serve as exit points.

  • Blood and tissue: Bloodborne pathogens can be transmitted through blood.

Modes of Transmission

  • Contact transmission: Direct or indirect.

  • Droplet transmission: Via respiratory droplets from coughing or sneezing.

  • Airborne transmission: Smaller particles can stay in the air for prolonged periods.

Portals of Entry for Pathogens

  • Entry can occur through:

    • Respiratory tract

    • Gastrointestinal tract

    • Genitourinary tract

    • Breaks in skin and mucous membranes

    • Bloodstream (e.g., through needles)

Susceptible Host Factors

  • Degree of resistance to pathogens relies on:

    • Age, sex, race, heredity

    • White blood cell (WBC) count

    • Skin integrity

    • pH of gastrointestinal and genitourinary tracts

    • Overall health status

    • Immunization history

    • Stress levels

    • Use of medical devices (e.g. catheters)

Stages of Infection

  • Incubation Period: Time between pathogen invasion and appearance of symptoms; may last from days to weeks.

  • Prodromal Stage: Nonspecific signs and symptoms (e.g., malaise, low-grade fever); highly contagious and lasting hours to days.

  • Full Stage of Illness: Characterized by specific signs and symptoms, which can be localized or systemic depending on the illness.

  • Convalescent Period: Recovery phase; signs and symptoms disappear, and patient health returns, although it may not revert to the pre-illness condition.

Body's Defense Against Infection

  • 1st line of defense: Skin and mucous membranes; body's normal flora in GI tract.

  • Inflammatory response: A localized response to injury or infection aimed at removing dead tissue and promoting healing.

  • Immune response: Involves antigen-antibody actions and cell mediated immune responses.

Inflammatory Response

  • Protective Mechanism: Localized and systemic response aimed at eliminating pathogens and repairing damaged tissue.

  • Cardinal Signs & Symptoms:

    • Redness

    • Heat

    • Pain

    • Swelling

    • Loss of function

  • Vascular Response:

    • Vasoconstriction: Confines area of injury and limits damage.

    • Vasodilation: Increases blood flow to promote healing.

  • Cellular Response: White blood cells (WBCs) migrate to the injury site to engulf pathogens and debris.

Immune Response

  • Antigen: Foreign material that induces an immune response.

  • Antibody: A protein produced by the immune system to neutralize or destroy pathogens.

  • Cell-mediated immunity: Involves the increase of WBCs to destroy foreign materials.

Blood Tests and Indicators of Infection

  • CBC with differential: Normal WBC count ranges from 5,000 to 10,000/mm³, various types (e.g., neutrophils, lymphocytes) indicate specific infections.

  • Elevated erythrocyte sedimentation rate (ESR): Indicates inflammation.

  • Cultures: Presence of pathogens in urine, blood, sputum, or wound drainage indicates infection.

Health Care-Associated Infections (HAIs)

  • Risk Factors:

    • Skin integrity

    • Age

    • Multiple illnesses

    • Invasive procedures/indwelling medical devices

    • Broad-spectrum antibiotics

    • Poor aseptic technique

    • Multiple healthcare personnel involvement

    • Extended hospitalization

  • Common HAIs:

    • Catheter-associated urinary tract infections (CAUTIs)

    • Surgical site infections (SSIs)

    • Central line-associated bloodstream infections (CLABSIs)

    • Ventilator-associated pneumonia (VAP)

Multidrug-Resistant Organisms (MDRO)

  • Examples include:

    • Methicillin-resistant Staphylococcus aureus (MRSA)

    • Vancomycin-resistant Enterococcus (VRE)

    • Clostridium difficile (C. diff)

  • Prevention:

    • Contact precautions

    • Medical asepsis

    • Handwashing specifically when C. diff is involved.

Disinfection and Sterilization

  • Disinfection: Destroys all pathogens except spores.

  • Sterilization: Destroys all microorganisms, including spores.

  • Importance of cleaning equipment between patients.

Personal Protective Equipment (PPE)

  • Donning (putting on):

    • Gown

    • Mask

    • Goggles/Face shield

    • Gloves

  • Doffing (removing):

    • Gloves

    • Goggles/Face Shield

    • Gown

    • Mask

Effectiveness of Masks

  • Type N95 Particulate Respirator:

    • 95% effective at filtering particles.

Isolation Room Requirements

  • Characteristics:

    • Private rooms (some are negative pressure airflow)

    • All equipment in contact with patients is considered contaminated.

    • Patients may need to wear masks when transported to other areas.

Surgical Asepsis

  • Key in operating rooms, labor/delivery areas, certain testing spots, and during bedside procedures such as:

    • Insertion of urinary catheters

    • Sterile dressing changes

    • Central line placements

    • Preparing and injecting medications.

Nursing Process

  • Assessment:

    • Check immunizations

    • Observe nonverbal clues

    • History of current disease

    • Signs/symptoms of local/systemic infection

    • Laboratory data.

  • Diagnosis:

    • Infection risk

    • Alteration in skin integrity

    • Inadequate vaccinations

    • Insufficient knowledge for pathogen avoidance.

  • Outcomes Identification & Planning:

    • Patients demonstrate effective hand hygiene

    • Identify signs of infection by shift end

    • Adhere to infection control during shifts.

  • Implementation:

    • Follow isolation precautions

    • Perform hand hygiene with the five moments of hand hygiene

    • Use appropriate PPE.

  • Evaluation:

    • Patients identifying signs/symptoms (met or not met).

Principles of Wound Healing

  • Intact skin is the first defense against microorganisms.

  • Hand hygiene is critical in wound care.

  • A proper blood supply is essential for adequate healing.

  • Healing is optimal when wounds are clean of foreign materials.

  • Factors that impact healing include wound condition and overall health, especially nutrition.

Systemic Factors Affecting Wound Healing

  • Age: Children and healthy adults tend to heal more quickly.

  • Circulation and Oxygenation: Adequate blood flow is necessary.

  • Nutritional Status: Requires protein, vitamin C, zinc for healing.

  • Health Status: Corticosteroids and radiation therapy can delay recovery.

  • Immunosuppression: Impacts healing capabilities.

  • Medications: Certain drugs may hinder wound recovery.

Types of Wounds

  • Intentional vs. Unintentional:

    • Intentional: Result from surgical procedures.

    • Unintentional: Result from accidents or trauma.

  • Open vs. Closed:

    • Open: Skin is broken, introducing risk of infection.

    • Closed: Skin remains intact but may have soft tissue damage.

  • Acute vs. Chronic:

    • Acute: e.g., surgical wounds.

    • Chronic: e.g., pressure ulcers.

Tissue Repair Mechanisms

  • Primary Intention: Clean surgical incisions that heal by direct closure.

  • Secondary Intention: Wounds heal from the inside out, common in large wounds or those that get infected.

  • Tertiary Intention: Wounds are left open to allow drainage and closure is delayed until healing has progressed.

Phases of Wound Healing

  • Hemostasis Phase:

    • Begins immediately after injury; involves blood vessel constriction and clot formation.

  • Inflammatory Phase:

    • Lasts 2 to 3 days; characterized by WBC activity and presence of macrophages that clean the wound.

    • Expected findings include redness, exudate, pain, heat, and swelling.

  • Proliferation Phase:

    • Fibroblasts build new tissue, capillaries grow, epithelial cells migrate to form a thin layer over the wound; granulation tissue forms a foundation.

  • Maturation Phase:

    • Final stage which starts 3 weeks post-injury and may last for months; collagen remodeling occurs leading to scar formation.

Wound Complications

  • Infection: Presence of pathogens causes symptoms such as increased redness, heat, and purulent drainage.

  • Hemorrhage: Excessive bleeding from a wound.

  • Dehiscence: Separation of wound layers under stress during healing.

  • Evisceration: Protrusion of internal organs due to complete wound separation.

  • Fistula Formation: Abnormal passage between organs or surface and an organ.

Wound Assessment

  • Evaluation Parameters:

    • Inspect for appearance and drainage.

    • Assess for smells, pain, sutures, and potential complications.

    • Consider psychological effects on the patient such as anxiety and changes in body image.

Presence of Infection Indicators

  • Swelling and deep red coloration.

  • Increased temperature upon palpation.

  • Increased drainage, potentially purulent.

  • Foul odor and separation of wound edges may indicate dehiscence.

Hot and Cold Treatments

  • Purpose: To bring about changes in body temperature locally or systematically based on application method and duration.

  • Cold Application Effects:

    • Constricts blood vessels, reduces muscle spasms, provides comfort, alters tissue sensitivity, can cause prolonged exposure effects including goosebumps and tissue damage.

  • Heat Application Effects:

    • Dilates peripheral blood vessels, increases metabolism, reduces muscle tension, and promotes healing; prolonged exposure can lead to sweating and cardiovascular changes.

Questions About Infection and Inflammation

  • Key questions in nursing assessments and care planning can revolve around what the infection is, when it occurs, its transmission, and treatment options.