Transcript Chapter 3 - Delmar Cengage Learning

Chapter 26
Infection Control
Infection Control
 Infection control practices are directed at
controlling or eliminating sources of
infection in the health care agency,
home, or community.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
26-2
Pathogens, Infection, and
Colonization
 Pathogenicity is the ability of a
microorganism to produce disease.
 Microorganisms that cause diseases in
humans are called pathogens.
 Virulence is the degree of pathogenicity
of an infection’s microorganism.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
26-3
Pathogens, Infection, and
Colonization
 Infection is an invasion and multiplication
of microorganisms in body tissue that
results in cellular injury.
 These microorganisms are called
infectious agents.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
26-4
Pathogens, Infection, and
Colonization
 Communicable Disease
• The result of a communicable agent being
transmitted to a client by direct or indirect
contact, through a vehicle (or vector) or
airborne route
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
26-5
Pathogens, Infection, and
Colonization
 Colonization is the multiplication of
microorganisms on or within a host that
does not result in cellular injury.
 Flora are the vegetation of
microorganisms on the human body.
• Resident flora
• Transient flora
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
26-6
Agent, Host, and Environment
 Agents capable of causing disease:
• Biological agents
• Chemical agents
• Physical agents
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
26-7
Agent, Host, and Environment
 A host is a simple or complex organism
that can be affected by an agent.
• A susceptible host is a person who lacks
resistance to an agent.
• A compromised host is a person whose
normal defense mechanisms are impaired
and who is therefore susceptible to infection.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
26-8
Agent, Host and Environment
 The environment consists of everything
other than the agent and host.
•
•
•
•
•
Water, food, plants, animals
Housing conditions
Noise
Meteorological conditions
Environmental chemicals
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
26-9
Chain of Infection






Microorganism (infectious agent)
Source or reservoir
Portal of exit from reservoir
Mode of transmission
Portal of entry into host
Susceptible host
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
26-10
Infectious Agents
(Microorganisms)
 Agents that produce infections can
consist of bacteria, viruses, fungi,
protozoa, and rickettsia
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
26-11
Infectious Agents
 The ability of a microorganism to infect a
client is related to:
• Virulence of the agent
• Number of microorganisms present
• Ability of the agent to enter and live in the
client
• Susceptibility of the client
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
26-12
Infectious Agents
 Resident Infectious Agents
• Microorganisms which are always present
on skin.
• Can be reduced through handwashing, but
not totally removed.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
26-13
Infectious Agents
 Transient Infectious Agents
• Agents that are picked up by the skin from
another person or object.
• Attach themselves to the skin and then may
be transmitted to a susceptible host.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
26-14
Source or Reservoir
 Required for the microorganism to
survive while awaiting a host.
 May allow the organism to multiply,
making it more dangerous.
• The human body is the most common
reservoir.
• Food, plants, animals, and feces are other
common reservoirs.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
26-15
Portal of Exit
 Pathway by which pathogens leave the
body of a host. Accessed by:
• Direct Contact
• Indirect Contact
• Airborne Transmission
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
26-16
Portal of Exit
 Direct Contact
• Transmission of disease from the host
• Touching, kissing, and sexual intercourse
 Sources of Direct Contact
• Skin, mucus membranes, urine, feces,
reproductive tract, blood
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
26-17
Portal of Exit
 Indirect Contact
• Occurs with the use of vehicles and vectors
 Vehicles (fomites)
• Toys, hospital supplies, instruments, dishes,
cups, or surgical dressings, food, fluids,
blood
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
26-18
Portal of Exit
 Airborne Transmission
• Transmission of infectious agents through
coughing, sneezing, dust particles
• Usually entry via the person’s respiratory
tract
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
26-19
Portal of Entry
 Pathway by which infectious agents gain
access to the body
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
26-20
Susceptible Host
 A person with a reduced immune
response has increased susceptibility.
 The immune response is the body’s
natural defense against infection.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
26-21
Factors Influencing Production
of an Infectious Disease






Age
Heredity
Stress
Surgery
Nutrition
Health Status
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
26-22
Factors Influencing Production
of an Infectious Disease
 Age
• The elderly and children under two years of
age are at greatest risk.
 Heredity
• Conditions or diseases resulting in the
absence of or inability to form immune
defenses.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
26-23
Factors Influencing Production
of an Infectious Disease
 Stress
• Increase in metabolic rate which results in
using up stored energy
• Elevation of blood cortisol, decreasing antiinflammatory responses
• Continued stress produces exhaustion,
further depleting ability to ward off infection.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
26-24
Factors Influencing Production
of an Infectious Disease
 Surgery
• Eliminates primary barrier of infection.
• Predisposes clients to surgical site
infections.
• Localized infection at wound site can
progress to a systemic infection.
• Additional risks include catheters and tubes.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
26-25
Factors Influencing Production
of an Infectious Disease
 Nutrition
• Insufficient protein consumption reduces
antibody production and inhibits the body’s
ability to ward off infection.
 Health Status
• Clients with disease of their immune system
are at greater risk.
• Chronic diseases can predispose the client
to infection.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
26-26
Normal Defense Mechanisms
 Nonspecific and specific immune
defenses work in harmony to defend the
host from pathogens.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
26-27
Normal Defense Mechanisms
 Nonspecific Immune Defenses
• Protect the host from all microorganisms
• Not dependent on prior exposure to the
antigen
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
26-28
Nonspecific Immune Defenses







Skin and Normal Flora
Mucous Membranes
Sneeze, Cough Reflexes
Tearing Reflexes
Elimination
Acidic Environment
Inflammatory Response
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
26-29
Nonspecific Immune Defenses
 Skin
• Intact skin is the body’s first line of defense
against infection.
• Sebum is produced by the skin and contains
fatty acids that kill some bacteria.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
26-30
Nonspecific Immune Defenses
 Normal Flora
• Normal flora residing on the skin compete
with pathogenic flora for food and inhibit
their multiplication.
• Inappropriate antibiotic use may disrupt the
balance of normal flora.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
26-31
Nonspecific Immune Defenses
 Mucous Membranes
• Mucus entraps infectious agents and
contains substances that inhibit bacterial
growth.
• Cilia trap and propel mucus and
microorganisms away from the lungs.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
26-32
Nonspecific Immune Defenses
 Sneeze and Cough Reflexes
• Physically expel mucus and microorganisms
from the respiratory tract and oral cavity with
force
 Tearing Reflex
• Protects the eyes by continually flushing
away microorganisms
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
26-33
Nonspecific Immune Defenses
 Elimination Patterns and Acidic
Environment
•
•
•
•
Resident flora of the large intestines
Mechanical process of defecation
Flushing action of urination
Acidic environment of urine and vagina
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
26-34
Nonspecific Immune Defenses
 Inflammatory Response
• Tissue injury caused by bacteria, trauma,
chemicals, heat, or any other phenomenon
• Release of substances that produce
secondary changes in the tissue
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
26-35
Specific Immune Defense
(The Immune Responses)
 Immunity is a specific defense
mechanism that creates an immune
response to a specific invading antigen.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
26-36
Specific Immune Defense
(The Immune Responses)
 Immune Responses
•
•
•
•
•
Active immunity
Passive immunity
Acquired immunity
Natural immunity
Artificial immunity
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
26-37
Immune Responses
 Active immunity results from the
development within the body of
antibodies that neutralize the infective
agent.
 Passive immunity is acquired by the
introduction of preformed antibodies.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
26-38
Immune Responses
 Acquired immunity results either from
exposure to an antigen or from the
passive injection of immunoglobulins.
 Natural immunity refers to the genetically
determined response of protection within
a specific species.
 Artificial immunity is produced following a
vaccine.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
26-39
The Humoral Immune
Response
 B lymphocytes recognize the antigen as
an enemy.
 Immunoglobulins are plasma protein cells
that produce five different classes of
antibodies (IgM, IgG, IgA, IgD, and IgE).
 Immunoglobulins circulate throughout the
bloodstream for the purpose of
destroying antigens.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
26-40
Cell-Mediated Immunity
 Fights pathogens that survive inside
cells.
 Antigen stimulates the release of
activated T cells.
• T-helper cells
• T-suppressor cells
• T-cytotoxic cells
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
26-41
Localized Versus Systemic
Infections
 Infection results from tissue invasion and
damage by an infectious agent.
• Localized infections are limited to a defined
area or single organ.
• Systemic infections affect the entire body
and involve multiple organs.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
26-42
Four Stages of Infection




Incubation
Prodromal
Illness
Convalescence
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
26-43
Nosocomial Infections
 Infections acquired in a health care
setting that were not present or
incubating at the time of the client’s
admission
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
26-44
Common Sites of Nosocomial
Infections
 Urinary tract
 Surgical sites
 Respiratory tract
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
26-45
Nosocomial Infections
 Procedures identified as possible
sources of infection are:
•
•
•
•
•
Inadequate handwashing
Catheterization technique
Improper suctioning technique
Improper dressing-change technique
Contamination of closed drain system
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
26-46
Infection Chain
 Breaking the
chain of infection;
preventive
measures follow
each critical link in
the chain of
infection.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
26-47
Asepsis
 Asepsis is the absence of
microorganisms.
 Aseptic technique is the infection control
practice used to prevent the transmission
of pathogens.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
26-48
Medical Asepsis (Clean
Technique)
 Practices to reduce the number, growth,
and spread of microorganisms
• The most common cause of nosocomial
infections is contaminated hands of health
care providers.
• Wash hands before and after every client
contact.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
26-49
Surgical Asepsis (Sterile
Technique)
 Practices that eliminate all
microorganisms and spores from an
object or area
•
•
•
•
Surgical scrub
Surgical attire
Sterile fields
Sterile instruments and equipment
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
26-50
Reduce or Eliminate Infectious
Agents
 Infection control practices to break the
chain of infection
• Cleansing
• Disinfection
• Sterilization
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
26-51
Reduce or Eliminate Infectious
Agents
 Cleansing
• Removal of soil or organic material from
instruments and equipment used in
providing care
• Water, mechanical action, detergent
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
26-52
Reduce or Eliminate Infectious
Agents
 Disinfection
• Elimination of pathogens, except spores,
from inanimate objects
• Use of germicides and antiseptics.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
26-53
Reduce or Eliminate Infectious
Agents
 Sterilization
• Methods used for total elimination of all
microorganisms including spores are:
-
Moist heat or steam (autoclave, boiling water)
Radiation
Chemicals
Ethylene oxide gas
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
26-54
Reduce or Eliminate Infectious
Agents
 Home Health Care Considerations
• Adapting acute care infection control
practice to the home care setting involves:
- Cleaning and disinfecting equipment
- Using clean versus sterile technique
- Handling of the nursing supply bag
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
26-55
Reduce or Eliminate Infectious
Agents
 Disposal of Infectious Waste in the Home
 Biological Hazard Symbol
 OSHA Regulations
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
26-56
Guidelines for Standards
Precautions
 Barrier Precautions
• Use of masks, gowns, and gloves to
minimize the risk of exposure to blood and
body fluids
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
26-57
Guidelines for Standards
Precautions
 Body Substances
•
•
•
•
Blood
All body fluids
Secretions
Contaminated items regardless of whether
or not they contain visible blood
• Nonintact skin
• Mucous membranes
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
26-58
Role of Health Care Personnel and
Health Agencies in Infection Control




Mask and eye protection or face shield
Non-sterile gown
Tuberculosis masks
Isolation precautions initiated when
positive cultures from a draining wound
are reported
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
26-59
Role of Health Care Personnel and
Health Agencies in Infection Control
 This nurse is interacting with a client who requires
isolation precautions.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
26-60
Role of Health Care Personnel and
Health Agencies in Infection Control




Reinforce adherence to isolation.
Post signs indicating type of isolation.
Provide necessary supplies.
Place clients in a private room with
adequate ventilation.
 Use disposable supplies and equipment.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
26-61
Role of Health Care Personnel and
Health Agencies in Infection Control
 Labeling of all articles leaving the room
 Use of impermeable bags or double
bagging
 Client and family instruction
 Alert to psychological discomfort
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
26-62
Role of Health Care Personnel and
Health Agencies in Infection Control
 Blood Borne Pathogen Exposure
• OSHA requires that all health agencies
make available the hepatitis B vaccine and
vaccination series to all employees.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
26-63
Role of Health Care Personnel and
Health Agencies in Infection Control
 Exposure Control Plan
• Begins with standard precautions and
moves to postexposure prophylaxis
• Specific follow-up for blood-borne pathogens
• Postexposure prophylaxis only in cases of
highest risk
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
26-64
Alternative Therapies Used to
Treat Infections
 Herbal Products
• Antimicrobial action
• Augment and vitalize the body’s own
defenses
 Client’s alternative practices should be
documented.
 Possible adverse reactions are possible
when used with prescribed drugs.
Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
26-65