Lab Values and Infection Control

Lab Values Document

A clarification document is available as a study guide.
The next fundamentals class will be in the back hall in the EN2 classroom (+1 275). An announcement will be sent out.
The mom class (health history, baseline, and lab) is from 8:00 to 4:30.
Med pass class: Drug medications and injections.

Lab Values Module

Refer to the comprehensive document in the lab value module for lab values.
Lab Value handout due July 30, handwritten.
It's harder to plagiarize and easier to remember if hand written.
Base the document off of presentations, Dynamic Health, or a combination. Groups will present on topics like sodium chloride in a couple of weeks.
The first section is often forgotten and is worth 50 points. The overall assignment is worth 300 points.
Keep the information brief.
Sign-ups for presentations will be available later today.
Work in teams of two to three people.
Create and present a PowerPoint (or another format) under five minutes, mirroring the template.
Submit the PowerPoint (or PDF) the night before.
Cite sources, and read the rubric.

Dynamic Health and Lab Value Quizzes

Use Dynamic Health for lab value quizzes.
The first quiz is open today and due by the 7th, focusing on white blood cells.
There will be eight quizzes in all, occurring weekly or every other week.

White Blood Cells

White blood cells (leukocytes) are part of the immune system.
Drawn as part of the CBC (complete blood count).
If we want to see the components or find different components of white blood cells and parts, then you'll do a CDC with the differential.

Function of White Blood Cells

Cells of the immune system.
Indicate disease or illness, especially infection (fungal, protozoan, parasitic).
Protect against infection.

Components of White Blood Cells (Differential)

Neutrophils: first responders, the largest amount of WBC, nonspecific. Eat every bad thing in the body.
Basophils: non-specific immune response; increase with inflammation, play a role in asthma.
Eosinophils: produce allergy symptoms; increase during allergy season (grass, etc.).
Lymphocytes: produce antibodies, remember invaders, backup plan; make antibiotics if they see returning invaders.
Monocytes: clean up debris after the "war" is over.

Normal White Blood Cell Count (Adults)

$4,500 - 11,000$
Leukopenia: Below 4,500.
Leukocytosis: Above 11,000 (usually indicative of infection).

Leukopenia

Less than 4,500.
Indicative of disease process (sepsis, HIV, lupus).
Manifestations/Signs & Symptoms: Related to the cause, not leukopenia itself.
- Often infection from a disease process
- Sore throat, fatigue, hives, rash, asymptomatic, or related to lupus.
What to do about it:
- Keep sick people away, protective isolation, antibiotics, steroids, antiviral medications, antipyretics.

Leukocytosis

Elevated WBC count.
Differential matters here
Related to the cause.
- Example: if you have a parasitic infection, it'd be Eosinophils.
Considerations/Interventions:
- Not always medication.
- Hookworm (anti-parasitic/antifungal).
- Good hygiene, avoid allergens, antihistamines.

Infection Control/Asepsis

Dr. Lister created ACE septic in 1967.
Antiseptic (or aseptic) surgery: Used carbolic acid (phenol) to sterilize wounds, instruments, and surgical fields.
True antiseptic surgery became a thing in the 1890s when it caught on in The United States.
Listerine: Doctors & chemists created Listerine that was based off of his antiseptic surgeries.
One of the most effective ingredients of Listerine is alcohol (ethanol), which is toxic to bacteria.

Learning Outcomes

Chapter 20 in the textbook.
Nurses need to know infection control to:
- Protect themselves and protect patients
- Reduce health care costs
- Follow standard practices and policies
- Understand the infectious process

Healthcare-Associated Infections (HAIs)

HAIs are one of the top 10 leading causes of death in The US:
- 99,000 associated deaths.
Clostridium difficile (C. Diff) is one of the most common HAIs.
CAUTI (Catheter-Associated Urinary Tract Infection) accounts for almost a third of HAIs.
HAI acquired is the same as nosocomial. So, they're all interchangeable.
Goal: Keep patients safe from getting an HAI.
HAIs is associated with healthcare in general.
HAI & nosocomial, call it the same. In a healthcare envrionment.

Chain of Infection

Predictable pattern of how infection occurs.
Infectious Agent:
- Bacteria, viruses, fungi, protozoa, parasites.
- Pathogen: Microorganism that causes a problem/infection.
- Opportunistic pathogens: Cause infection more likely if the person's immune response is lower
- Normal flora: Microorganisms that live in or on our body.
  - Transient: Unhoused flora visits different places, not always there.
  - Resident: Built a home inside us.

Four Things Needed For the Infectious Agent to Cause a Problem

Virulence: Strength of the organism.
Ability to survive in the host: Depends on the immune system (young, old, immunocompromised).
Number of organisms: Viral load (more viral load = more likely to get sick).
Ability of the body to prevent the infection (if weak, more likely to get the infection).

Reservoir

Needs somewhere to grow and live.
Microorganisms love warmth (body temperature).
Need moisture, most need oxygen (aerobic) but some anaerobic ones that don't need oxygen, like tetanus.
pH needs to be right (5 to 8, more basic/neutral).
Common Reservoir: Our body (has all of the above).
Other sources: soil (tetanus), water (cholera), food (salmonella), surfaces (C. Diff).
Carriers: Host who is asymptomatic and can pass along the infection (Typhoid Mary).
Darkness: sterilzed by UV lights is good.

Portal of Exit

Needs to get out and spread its joy.
Usually spread by body fluids (urine, feces, vomit, semen, breast milk).
The body's natural response is to get rid of them (vomit, sneeze, cough).

Mode of Transmission

The journey of the germ.
- Contact: Touching, kissing.
  - Direct: Direct contact with the pathogen/source.
  - Indirect: Through something in between (fomite - object).
  - Droplet: Airborne, travels short distances with a cough.
  - Airborne: Smaller particles that travel farther.
  - Vector: Mosquito, tick-bite carrying a disease.
Portal of entry: Normal openings (mouth, nose, urethra) or abnormal openings (surgical incision, wound).

Susceptible Host

Young, old, environment, no nutrition, compromised immune system, medications, invasive procedures.

Classifying Infections

How it was acquired, where the volume is, and how long it lasts.
Local vs Systemic
- Local: Right here, like a paper cut.
- Systemic: Something is in your whole body (bacteria in the blood/lymph, sepsis).
Primary vs Secondary
- Primary: First infection.
- Secondary: Arises because of the primary infection.
  - (Related to an opportunistic infection).
Exogenous vs Endogenous
- Exogenous: External.
- Endogenous: Comes from within.
Acute vs Chronic
- Acute: Short and fast.
- Chronic: Low and slow, lasts weeks/years.
Latent: You'll have long periods where there's not a problem, and then they have an exacerbation of sorts.

Stages of Infection

Incubation: Pathogen gets in, contagious, but no symptoms.
Prodromal stage: Vague symptoms, "do I feel sick?"
Illness: Active signs and symptoms, very contagious.
Stage of Decline: Still contagious but starting to feel better.
Convalescent stage: Recovering/healing, can take a long time.

Emerging Pathogens and Diseases

Endemic: Common illness in a small area.
Outbreak: Numbers rise in a region.
Epidemic: Larger spread to a bigger region.
Pandemic: Worldwide infection.

Antibiotic Resistance

Due to the amount of antibiotics used, resistance is increasing.
People at risk: chronic exposure to antibiotics, immune-deficient, acute hospitalizations, advanced age.

Body's Defenses Against Infection

Primary Defenses (Castle Walls):
- Skin, mucous membranes, respiratory tract (cilia), tears (lysozymes), GI tract (acidity), GU tract (mucous membranes).
Secondary Defenses (Castle Guards, Fast & Furious, Nonspecific):
- Phagocytosis: Neutrophils (first responders) kill the invader.
- Complement Cascade: Blood proteins, alarm system.
- Basophils Release Histamine: Causes inflammation by dilating the blood vessels, allowing other WBCs to come in.
- Fever: Pathogens love warmth, but above 101°F is deadly.
Tertiary Defenses (Special Forces):
- Specific, slower to respond, make special weapons (antibodies).
- Active Immunity: Body makes own antibodies.
- Passive Immunity: Given to you.
- Specific Immunity: Specialized WBCs (B cells mark, T cells destroy).
- B cells - mark the outside of the cell,
- T cells go from the inside and destroy it.
  - cellular and Humoral.
  - Humoral comes from the bone marrow, They're both created in the bone marrow.
  - the T cells mature in the thymus.

Active vs Passive Immunity

Active - Your body has to do somethin.
Passive - Your body is given something.

Types of Immunity

Naturally Acquired Active: Exposed to an antigen, get ill, and recover (chickenpox).
Naturally Acquired Passive: Breast milk, colostrum, placenta (antibodies given naturally).
Artificially Acquired Active: Through a vaccine/immunization (attenuated/weak virus triggers antibody production).
Artificially Acquired Passive: Shot/infusion of antibodies (antivenom, IgG, short-term).
For passive its somewhat temporary.

Post Susceptibility

Very young, very old, breaks in first line of defense (surgery, wound), illness/injury, tobacco use, multiple sex partners, chronic diseases (diabetes & sugar), medications (steroids), invasive procedures.

Nursing History

Informal interrogation to find out where the infection came from, how long you've had it, and contributing factors (probing questions).

Promoting Wellness

Nutrition, hygiene (handwashing), rest/sleep, exercise, stress reduction.

Medical Aseptic vs Surgical Aseptic

Medical Aseptic: Used for every patient, decreasing the amount of pathogens or microorganisms by medical aid sepsis by including handwashing and using PPE.
- Pretend every patient has some desease you canot see.
Surgical Aseptic: Elimination that. By surgical asepsis with sterile procedures or surgery. * Only thing ot can't eliminate is is a prion.

Hand Hygiene

Single most important activity for preventing infection.
Hands of healthcare workers are the biggest reason for the spread of infection.
Wash hands for at least 15 seconds (up to 20).
Sanitizer (Hand Rub):
- Use dime size - 30 seconds.
- 20-30 seconds, dime to quarter size, at least 60% alcohol.
Use friction, and use towels (vs hand dryers).
Handwashing kills C. Diff and norovirus, sanitizers do not.
The book suggests calling people out for nut washing there hands as a public training.

Maintaining a Clean Environment

Clean: Visible dirty surfaces (soap and water).
Disinfect: Using chemical means (purple wipes).
Sterilize: Critical items (remove all pathogens except prions).

Standard Precautions vs Transmission Based Precautions

Both use PPE at different levels.
*All precautions we use PPE.
Standard Precautions: Use for everyone, medical asepsis.
Transmission-Based Precautions: Contact, droplet, airborne (gown, mask, gloves, goggles, N95).
For medically sepsis ( PPE is personal protection)
it depends on if it is standard for enery one where we need to protect ourselves.

Donning and Doffing PPE

Bottoms up:

gown
mask
goggles
gloves

*Donning - before contact with anything that can cause an infection. Doffing - before leaving the room.
n 90 five and a mask. You can keep that on till you leave the room. ( for droplet/oriborne)

Doffing- Aphabetical order - Taking PPF off. - Glove, Goggle, Gown and mask- (GGGM)

Protective Isolation

For people getting chemo or have a bone marrow transplant--to prevent them from getting sick. Also no Live flowers.
Clean equipment before it goes in and after.
Healthy people only in the room.
Put PPE on outside of the room.
And we can still remove it inside the room, but its okay in protective Isolation, to remove the room on the outside of the room.
You are going to see some sort of stop side and a cart outside the room. You can use Gown, mask and gloves. In protective Isolation.
Protective Isolation- We are protecting the patient.
When Double, Bag, person in room is in PPE and Bags stuff.. Then 2 employee is needed on the outside folding another bag , and you put it in there.
In double bagging has to be done if It cano't have more then 25 miles.. Or It has to be cleaned.

Sharps Disposal & Lab Specimens

Sharps: Don't recap dirty needles. Single-hand recap clean ones, or use the safety shield, then directtly in the sharps.
Lab Specimens: Use gloves, put in biohazard bag