Transcript 12 L.Interventions for Clients with Infection

Interventions for
Clients with
Infection
Types of Infection
 Local
 Systemic
 Acute
 Chronic
Nosocomial Infections
 Infections
that are associated with
the delivery of health care services in
a health care facility
 Point
of origin
1. Endogenous
2. Exogenous
3. Iatrogenic
Risks for Nosocomial Infection
 Poor
hand washing
 Compromised host – surgery/illness
 Improper procedure technique –
dressing, suctioning, catherization
 Improper cleaning/maintenance of
invasive devices – foley catheter, IV
line
 Contamination of closed drainage
system – chest tubes
Chain of Infection
 Etiologic
Agent
 Reservoir
 Portal of Exit from Reservoir
 Method of Transmission
 Portal of Entry into Susceptible Host
 Susceptible Host
Etiologic Agents
 Bacteria
 Viruses
 Fungi
 Parasites
 Resident
 Transient
Reservoir
 Environmental
 Human
 Animal/Insect
Portal of Exit from Reservoir
 Mouth,
nose
 Urinary tract
 Wounds
 Device insertion sites
 Other orifices
Method of Transmission
 Direct
 Indirect
Vehicle-borne
Vector-borne
 Airborne
Factors Increasing Susceptibility to
Infection
Age
 Heredity
 Level of stress
 Nutritional status
 Medications
 Illness –
acute/chronic

Body Defenses Against Infection
 Anatomic
& Physiologic Barriers
 Inflammatory
Response
 Antibody-Mediated
 Cell-Mediated
Defenses
Defenses
Inflammatory Response

Five Signs:
Pain
2. Swelling
3. Redness
4. Heat
5. Impaired Function
1.

Three Stages:
Vascular and
cellular responses
2. Exudate production
3. Reparative phase
1.
Antibody-Mediated Defenses
 Active
Infectious microorganisms
Vaccines
 Passive
(Acquired)
Natural – breast milk
Artificial – immune serum
Cell-Mediated Defenses
 T-cell
system – exposure to antigen
causes release into lymph system
1. Helper
2. Cytotoxic
3. Suppressor
Course of Infection
 Incubation
period – time between
initial contact and appearance of
symptoms
 Prodromal
stage – time from onset of
nonspecific symptoms to more
specific symptoms – transmission
possible
Course of Infection
 Full/Illness
stage – time that specific
symptoms present – acute –
transmission possible
 Convalescence
– time when
symptoms resolve and host returns
to pre-illness state
Laboratory Tests
1.
2.
3.
White blood cell count – Leukocyte
– nonspecific unless differential
done to break down types of WBC’s
– normal 4,500 – 11,000
Erythrocyte sedimentation rate –
ESR – increased rate of RBC’s
settling in presence of inflammatory
process
Culture & Sensitivity – C&S urine,
blood, sputum, wound – determines
Nursing Diagnosis
 Risk
for Infection – PRIMARY
 Potential Complications of Infection
 Impaired Physical Mobility
 Imbalanced Nutrition
 Acute Pain
 Impaired Social Interaction/Social
Isolation
 Situational Low Self-Esteem
 Anxiety
Interventions to Reduce Risk of
Infection
 Preventing
1. Hand
Nosocomial Infections:
washing
2. Proper technique
3. Environmental controls
4. Management of clients at risk
Interventions to Reduce Risk of
Infection
 Supporting
Host:
Defenses of Susceptible
1. Hygiene
2. Nutrition
3. Fluid
4. Rest
and sleep
5. Immunizations
6. Stress
Interventions to Reduce Risk of
Infection
 Cleaning,
1. Cleaning
Disinfecting, Sterilizing
inhibits growth of
microorganisms
2. Disinfecting with chemicals –
bacteriostatic vs. bactericidial
3. Sterilizing – destroys all
microorganisms – including
spores/viruses – moist heat, gas,
boiling water, radiation
Standard Precautions
 All
clients
 Apply blood, body fluids,
excretions/secretions, non-intact
skin, mucous membranes
 Designed to reduce risk of
transmission from all sources
Airborne Precautions
 Infections
spread through air – TB,
varicella, rubeola
 Private room – negative air
pressure/air exchange
 Door closed
 Respiratory equipment
 Mask client in transport
Droplet Precautions
 Large
particle droplet infections –
rubella, mumps, scarlet fever, some
pneumonias
 Private room or cohort
 Respiratory protective equipment –
within 3 feet of client
 Transport client with mask
Contact Precautions
 Infections
spread by direct/indirect
contact – wound infections, scabies,
antibiotic resistant infections –
MRSA, VRE
 Private room or cohort
 Gloves entering room – wash hands
in room
 Personal protective equipment when
in direct contact with infected body
secretions
Protective Isolation
 Protects
clients with compromised
immune systems
 Private room
 Protective garb worn in room –
gloves, gown, mask – may vary with
facility
 No fresh fruits, vegetables, flowers
 Client mask outside of room
Definitions
 Pathogen
is any diseaseproducing microorganism.
 Communicable is via person-toperson contact.
 Pathogenicity is the ability to
cause disease.
 Virulence is the degree of
communicability.
(Continued)
Definitions (Continued)
 Normal
flora often competes with
microorganisms to prevent
infections.
 Colonization is the
microorganism present in tissue,
but not yet causing symptomatic
disease.
Overview of Chain of Infection
 Reservoirs
 Pathogens
– Toxins
– Exotoxins
– Endotoxins
Immunity
 Resistance
to infection is usually
associated with the presence of
antibodies or cells acting on
specific microorganisms.
(Continued)
Immunity (Continued)
 Passive
immunity is of short
duration, either naturally by
placental transfer or artificially
by injection of antibodies.
 Active immunity lasts for years
and occurs naturally by infection
or artificially by stimulation
(vaccine) of immune defenses.
Portal of Entry Sites
 Respiratory
tract
 Gastrointestinal tract
 Genitourinary tract
 Skin/mucous membranes
 Bloodstream
Mode of Transmission
 Contact
transmission by direct or
indirect contact
 Droplet transmission such as in
influenza
 Airborne transmission such as in
tuberculosis
 Vector-borne transmission
involving insect or animal
carriers, such as in Lyme disease
Physiologic Defenses Against
Infection
 Body
tissues
 Phagocytosis
 Inflammation
 Specific defenses
– Antibody-mediated immune system
– Cell-mediated immunity
Infection Control in Inpatient
Health Care Agencies
 Nosocomial
or health care–
associated infections are
infections acquired in the
inpatient health care setting
which were not present or
incubating at admission.
 Endogenous infection is from a
client’s flora.
 Exogenous infection is from
outside the client, often from the
Methods of Infection Control
 Practice
hand hygiene and
proper hand washing.
 Artificial fingernails create poor
hand hygiene.
 Gloves should be worn.
 The CDC provides guidelines for
disinfection and sterilization,
outlining standard precautions
for all modes of transmission.
Multiple Drug–Resistant
Infections
 Multiple
drug–resistant
infections are no more
transmissible than their drugsensitive counterparts, S. aureus
and Enterococcus organisms.
 To control antimicrobial
resistance in health care
settings, see the CDC program.
Problems from Inadequate
Antimicrobial Therapy
 Noncompliance
or nonadherence
 Legal sanctions that compel a
client to complete treatment,
such as in the instance of
tuberculosis
 Septicemia
 Septic shock
Collaborative Management
 History
 Physical
assessment and clinical
manifestations
 Psychosocial assessment
(Continued)
Collaborative Management
(Continued)
 Laboratory
including:
assessment
– Culture and antibiotic sensitivity
testing
– Complete blood count
– Erythrocyte sedimentation rate
– Serologic testing
– Radiographic and other assessment
Hyperthermia Interventions
 Eliminate
the underlying cause of
hyperthermia and destroy the
causative microorganism.
 Manage fever by:
– Drug therapy: antimicrobial,
antipyretic therapy
– External cooling, fluid
administration, and fans
Risk of Social Isolation
 Interventions
include:
– Education about the mode of
transmission of infection and
mechanisms that spread it
– Assess coping mechanisms used in
the past.
– Maintain communication with the
client.
Health Teaching
 Education
on these topics is vital
to client’s understanding of
transmission prevention
precautions:
– Infection control
– Drug therapy
– Psychosocial support
– Health care resources