Transcript Chapter 7 Body Systems

Medical-Surgical Nursing:
Concepts & Practice
3rd edition
Chapter 6
Infection Prevention and Control
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Theory Objectives
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Analyze the factors that increase the risk of
infection.
Discuss how the body uses its natural
defensive mechanisms to protect against
infection.
Explain how fever plays a role in the
prevention of infection.
Describe the classic signs of infection.
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Theory Objectives (Cont.)
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Analyze situations that require the use of
Expanded Precautions.
List the types of personal protective
equipment and analyze situation for when
they should be used.
Describe factors that make older adults more
susceptible to infections.
Analyze factors that may impair the process
of healing and repair of damaged tissue.
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Clinical Practice Objectives
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Care for a patient whose condition requires
transmission-based precautions
From a day's patient assignment, determine
the factors present for each patient that are
risk factors for infection.
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Infectious Process and Disease
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An infection is the presence and growth of
pathogenic microorganisms in a susceptible
(lacking resistance) host, to the extent that
tissue damage occurs.
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The development of an infection depends n
the interrelationship between the host, the
agent, and the environment. (see page 100)
Box 6-1
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Infectious Process and Disease (Cont.)
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Communicable (passed from one person to
another) or noncommunicable
When an infection has occurred, the person
is considered communicable until the host is
no longer shedding infectious organisms.
This period of communicability varies by the
type of pathogen involved and the host’s
ability to fight off the infecting agent.
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Factors that Influence Infection
and Disease (Box 6-1)
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Risk of exposure
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Host characteristics
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Lifestyle, occupation, and socioeconomic status
Immunologic and nutritional status influence
resistance or susceptibility to the pathogen
Environmental factors
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Disease-Producing Pathogens
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Disease-producing pathogens include any
microorganism capable of producing disease.
Modes of transmission are airborne, contact,
and droplet.
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Hand hygiene and respiratory etiquette—cover
your cough or sneeze and performing hand
hygiene afterward.
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Categories of Microorganisms
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Bacteria (antibiotics)
Viruses (antivirals)
Protozoa
Rickettsia and chlamydia
Fungi (antifungals)
Mycoplasma
Others (helminths –worms and prions)
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The Body’s Defenses Against Infection
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The four primary lines of defense the body
has against infection are
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Skin and mucous membranes
Normal flora
Inflammatory response
Immune response
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Skin and Mucous Membranes
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Mechanical barrier
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Intact skin and mucous membranes provide a
protective covering for the more delicate and
vulnerable underlying tissues and organs.
Serve as portals of exit and entry
Chemical barriers
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Acids
Lysozymes
Cilia
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Normal Flora
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Present on skin and in mucous membranes
of the oral cavity, gastrointestinal tract, and
vagina
Help prevent excessive growth of pathogens
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Inflammatory Response.. 2nd line of
defense
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Basic purposes of the inflammatory response
include
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Neutralizing and destroying harmful agents
Limiting spread to other tissues in the body by
walling off organisms
Preparing the damaged tissues for repair
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Inflammatory Changes
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Inflammatory changes involve
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The cells of the damaged tissues and adjacent
connective tissues
The blood vessels in and near the site of injury
The blood cells, particularly the leukocytes
The macrophages and phagocyte activity
The immune system
The hormonal system
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Signs and Symptoms of Inflammation
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Local reactions—redness, heat, swelling, and
pain
Systemic reactions—headache, myalgia,
fever, diaphoresis, chills, anorexia, and
malaise
Chemical release and vascular changes
Immune response—the third line of defense
Hormonal response
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Protective and Defensive Mechanisms
Against Infection
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Innate (born with or natural) see
Box 6-2 pg 103
Acquired immunity (develops
throughout life)
Host susceptibility
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Degree of susceptibility depends
on general health, state of nutrition,
hormone balance, immune status,
and the presence of a chronic
disease such as diabetes mellitus
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Mechanisms Against Infection
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Antigen and antibodies
Bone marrow
Leukocytosis
Phagocytosis
Macrophages
Liver cells
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Antigen and Antibodies
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An antigen is a form of protein found on the
outside of cells that has the ability to identify it as
“self” (native) or “nonself” (foreign).
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It can stimulate the immune response to wipe out
microorganisms.
Antibodies, also known as immunoglobulins (Ig),
neutralize toxins and kill invading pathogens.
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IgM, IgG, IgA, IgE, IgD
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IgM Antibody
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Appears first if the body is exposed to an
antigen
Will bind to the antigen and work to clear the
pathogen from the body
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IgG Antibody
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Most abundant immunoglobulin found in the
body and is the only one that crosses the
placental barrier
Can also be given to provide passive
immunity until the body’s own immune system
can defend itself
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IgA Antibody
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Found in tears, mucus, saliva, gastric fluid,
colostrum, and sweat
Prevents pathogens from attaching to or
penetrating epithelial cells, such as the skin
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IgE Antibody
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Has the ability to bind to mast cells and
basophils and when triggered, releasing
histamine and heparin
This in turn stimulates a hypersensitive
reaction, as seen in bronchial asthma or
systemic anaphylaxis.
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IgD Antibody
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IgD works together with IgM.
Stimulates certain cells in the immune
system; however, its overall role in the
immune response is still unclear
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Bone Marrow
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Plays an important role in the manufacturing
of blood products that help the body defend
itself against infection
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Leukocytosis
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An increased number of leukocytes (white
blood cells [WBCs]), usually seen at the
beginning of an infection when the person’s
immune system has not been overly stressed
Leukocytosis is seen more often with
bacterial than viral infections.********
When infection does occur, the bone marrow
is stimulated to produce and release more
leukocytes to help the body fight off,
inactivate, and destroy the invading
pathogens.
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Phagocytosis
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Ingestion and digestion of bacteria
Assists the body in destroying invading pathogens
The body’s first line of defense at the cellular level
Within the first few hours of the onset of the
inflammatory process, monocytes swell (becoming
macrophages) and migrate to the site of
inflammation.
Neutrophils, a type of leukocyte, are released and
kill aerobic and anaerobic organisms.
After the macrophages and neutrophils engulf and
destroy bacteria and other foreign matter, they die,
producing an exudate (pus) composed of tissue,
fluid, dead cells, and their byproducts.
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Macrophages
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Monocytes (large leukocytes) that have left
the bloodstream and migrated into the tissues
They ingest and destroy pathogens and clear
away the cellular debris and dead neutrophils
in the latter stages of an infection.
Macrophages cleanse the lymphatic fluid as it
passes through the lymph nodes and perform
a similar action on the blood as it passes
through the liver and spleen.
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Liver Cells
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As part of the innate immune system, about
50% of all macrophage cells can be found in
the liver’s Kupffer cells.
These macrophages prevent invasion
mechanically or neutralize the pathogen
chemically (through the pH of body
secretions).
Macrophages also have the ability to destroy
bacteria that have found their way into the
blood circulation through the liver’s portal
system.
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Chain of Infection
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Prevention or control of infection is aimed at
interrupting any point within the chain of
infection.
See p 107
Figure 6-3
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Vectors
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Can transmit pathogens through their bites or
stings
Mosquitoes
Fleas
Ticks
Flies
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Reservoirs
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Any place a pathogen is normally found
Can be animate (living) such as people,
animals, and insects
Can be inanimate (nonliving), as found in soil,
in water, and on surfaces of objects such as a
cup or bed rails
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Infection Prevention and Control
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Perform diligent hand hygiene.
Remove rings, other jewelry, and artificial
fingernails or extenders.
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Standard Precautions – see Box 6-4
page 108
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Designed to prevent
transmission of microorganisms
from one patient to another and
protect health care workers from
unnecessary exposure to
infection
Used on all patients because
their potential for being
colonized or actual infections
are not always known
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Standard Precautions (Cont.)
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Barrier precautions, such as gloves or
isolation techniques that include the proper
handling and disposal of secretions,
excretions, and exudates, can prevent the
transmission of pathogens from one person
or object to another.
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Transmission-Based Precautions – see
Table 6-5 pg. 109
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Airborne infection isolation = TB, varicella
Contact isolation= MRSA, VRE ESBL +
Droplet isolation = Pneumonia, influenza,
strep, meningitits
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Personal Protective Equipment (PPE)
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The use of some type of barrier to protect a
person from exposure to bloodborne
pathogens, body fluids, or other potentially
infectious materials
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Gloves (consider latex allergy)
Cover gowns
Facemasks
Eye protection
Respirator masks
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Transplant Recipients
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Special airflow and filtration rooms with
positive air pressure
Smooth surfaces to aid in disinfection
Minimize the length of time the patient is
outside of the protective environment.
Ensure staff are free from signs and
symptoms of illness.
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Respiratory Hygiene
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Disposal of soiled materials
Hand hygiene
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Cough Etiquette
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Turning or covering the mouth when
coughing
Hand hygiene
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Interrupting Portal of Entry
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Use clean or sterile items.
Use effective hand hygiene techniques.
Immunization and measures to boost
immunity through proper nutrition and a
healthy lifestyle
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Health Care–Associated Infections
(HAIs)
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There are a number of sources of infection in
care settings.
Specific criteria that must be met for an
infection to be consider an HAI.
• Such as length of time in a facility before the
onset of the infection
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Costs of HAIs
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Human suffering
Prolonged hospital stays
Time lost from work
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Nursing Interventions to Prevent HAIs
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Hand hygiene
Reduce vascular catheter–related infections
Appropriate disposal of soiled or
contaminated linens
Review immunization status of the patient
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Infection Surveillance and Reporting
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Assess for signs and symptoms of infection.
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Unexpected elevation of temperature
Malaise
Cough
Loss of appetite
Foul-smelling urine
New-onset diarrhea
Wounds that are red, swollen, painful, or have a
foul-smelling discharge
Color of purulent drainage
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Infection Surveillance and Reporting
(Cont.)
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Identify patients who are more susceptible to
infection because they
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Are weakened by severe illness or injury
Have drainage tubes or catheters, intravenous
cannulas, or other invasive devices for monitoring
or treatment
Are very young or very old
Have had recent surgery
Are immunocompromised
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Destroying and Containing
Infectious Agents
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Goals of destroying and containing infectious
microorganisms are achieved by techniques
and methods that
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Kill the organisms or render them harmless
Isolate the sources of infection, so that they
cannot be spread to others
This is accomplished through medical or
surgical aseptic technique.
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Medical Asepsis
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Goal is to reduce microorganisms
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Hand hygiene
Separation or isolation of a patient
Appropriate precautions for handling and
disposing of contaminated articles
Cleansing and disinfection
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Surgical Asepsis
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Goal is to completely eliminate
microorganisms
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Sterilizing of instruments, skin, linen, and other
articles
Intravenous catheter insertion
Indwelling Foley catheter insertion
Placement of internal devices
Invasive procedures
Surgically aseptic environment
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Sepsis and Septic Shock
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Bacteremia
Systemic inflammatory response syndrome
(SIRS)
Septic shock
Multiorgan failure
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Assessment (Data Collection)
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Thorough nursing assessment of subjective
and objective data
Assess mental status, temperature, edema,
pulse, blood pressure, and urine output.
Watch for signs and symptoms of septic
shock.
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Older Adult Care Points
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Note the physiologic changes of aging.
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Decreased inflammatory and immune response;
little rise in temperature in the presence of
infection
Decrease in mental alertness; increased fatigue;
or sudden onset of confusion, irritability, or apathy
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Planning
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Use the body’s own defensive and healing
processes.
Obtain adequate rest, nutrition, and
hydration.
Be as free from physical discomfort as
possible.
Be free from as much mental anxiety or
depression as possible.
Ensure that sufficient oxygen and blood are
supplied to the infected tissues.
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Implementation
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Provide a quiet, comfortable environment.
Relieve the discomforts of fever and muscle
aches, accomplished by tepid sponge baths,
ice bags, antipyretics, and massage.
Warm compresses and the application of
heat, as appropriate, can also promote
healing.
Mild physical exercise promotes circulation
and helps some patients to relax.
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Implementation (Cont.)
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Administer antimicrobial
agents.
Maintain medical asepsis.
Monitor laboratory tests.
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Elevated WBC count, changes in
the distribution and number of
the various types of leukocytes,
an elevated erythrocyte
sedimentation rate (ESR), and
microbiology cultures that test
positive for microorganisms
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Implementation (Cont.)
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Bacteriologic tests
• Culture and sensitivity—multidrugresistant organisms
• Intradermal skin tests—tuberculosis,
coccidioidomycosis, and candidiasis
• Radiography (x-rays), computed
tomography (CT), or magnetic resonance
imaging (MRI) may be used to detect
changes in the tissues or organs, and
locate abscesses anywhere within the
body.
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Patient Teaching
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Provide patient and family teaching regarding
the infection, including the following.
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Purposes of diagnostic tests
Treatments
Special precautions
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Evaluation
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Temperature, pulse, and respirations are
within normal range.
WBC count and ESR are within normal limits
and cultures are negative.
Able to rest comfortably
Absence of or decrease in severity of pain
and discomfort
Fluid and nutritional needs are being met.
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Community Care Goals
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Promote sanitary standards
in communities.
Identify persons who are
highly susceptible to
infection and reduce their
chances of developing an
infectious disease.
Provide immunization
programs to protect people
against certain infectious
diseases.
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Home Care
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Hand hygiene
Clean surfaces
Safe food handling
Get immunized.
Use antibiotics appropriately.
Be careful with pets.
Avoid contact with wild animals.
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Audience Response Question 1
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Cross-infection among members of the household
can be prevented by which behavior(s)? (Select
all that apply.)
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5.
Sharing personal items
Practicing hand hygiene
Using bleach to clean surfaces
Sealing used dressings in impermeable bags
Washing soiled linens weekly
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Long-Term Care
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Older adults are more susceptible to
infection.
Chronic illnesses
Hand hygiene
Cleaning surfaces
Meticulous and timely skin care
Appropriate management of soiled linens
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