NCM 112 – Lecture CHAIN OF INFECTION

Care of Clients with Problems in Infectious,

Inflammatory and Immunologic Response

BASIC CONCEPT & TERMINOLOGIES

COLONIZATION
 used to describe microorganisms present
without host interference or interaction.
 Organisms reported in microbiology test results
often reflect colonization rather than infection.
 The patient’s health care team must interpret
microbiology test results accurately to ensure
appropriate treatment.
 A patient colonized with Staphylococcus Aureus
may have staphylococci on the skin without any
skin interruption or irritation
SUSCEPTIBLE HOST
INFECTION  For infection to occur, the host must be
 indicates a host interaction with an organism susceptible
 if the patient has an incision, S. aureus could
enter the wound, resulting in an immune PORTAL OF ENTRY
system reaction of local inflammation and  needed for the organism to gain access to the
migration of white cells to the site host
 Clinical evidence of redness, heat, and pain and
laboratory evidence of white blood cells on the MODE OF TRANSMISSION
wound specimen smear and microbiologic  serves as an intermediate means to transport
organism identification and introduce an infectious agent into a
susceptible host through a suitable port of
INFECTIOUS DISEASE entry
 the state in which the infected host displays a
decline in wellness due to the infection PORTAL OF EXIT
 when the host interacts immunologically with  to shed organisms to another or to the
an organism but remains symptom-free, the environment for transmission to occur
definition of infectious disease has not been
met. RESERVOIR
 severity ranges from mild to life-threatening  to provide nourishment for microorganisms
and enables further dispersal of the organism
IMPORTANCE OF MICROBIOLOGY REPORT
MEASURES TO BREAK THE CHAIN OF INFECTION

Microbiology report is a tool to be used along with

clinical indicators to determine if a patient is colonized,
infected, o diseased.

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 ORGANIZATIONS INVOLVED IN INFECTION CONTROL

 Inspects the workplace for potential hazards,

keeping records of workplace injuries and
illness, training employees to recognize safety
and health hazards, and educating employees
on precautions to prevent accidents EXPLANATORY NOTE:
The Constitution, Article II, Section 15, provides:
The State shall protect and promote the right to health
of the people and instill health consciousness among
them.

Three pandemics occurred during the 20th century: the

Spanish flu pandemic 1918; the Asian flu pandemic in
 Principal agencies involved in setting guidelines 1957; and the Hong Kong flu pandemic in 1968. The
about infection prevention Spanish flu pandemic was the most severe. Causing
500,000 deaths in the United States and more than
20,000,000 deaths worldwide.
PREVENTION OF INFECTION IN THE COMMUNITY
Recent studies suggest that avian influenza strains,
1. VACCINATION PROGRAMS which are endemic in wild birds and
 The goal of vaccination programs is to use
wide-scale efforts to prevent specific The best defense against influenza pandemics is a
infectious diseases from occurring in a heightened global surveillance system. In many of the
population. nations where the H5N1 avian flu has become endemic,
the early detection capabilities and the transparency in
2. PLANNING FOR A PANDEMIC health systems are severely lacking.
 Influenza pandemics are likely to be more
catastrophic than other anticipated public In addition to surveillance, pandemic preparedness
health problems because they last longer requires domestic and international coordination and
than other emergency events, often occur cooperation to ensure an adequate medical response,
in “waves,” deplete the available health including communication and information networks,
care workforce and reduce the supply of public health measures to prevent spread, use of
medical equipment because of their vaccination and antivirals, provision of health
widespread nature. outpatient and inpatient services, and maintenance of
core public functions.
The late Senator Miriam Defensor Santiago filed
Senate Bill no.1573 Pandemic & All-Hazards COMMON VACCINES
Preparedness Act.
MEASLES, MUMPS, AND RUBELLA VACCINE (MMR)
=  should be given to children at 12 to 15 months
of age, with repeat dosing at 4 to 6 years of
age, adults who have not received the MMR
vaccine should receive 1 to 2 doses.
 Transmission: droplet and direct contact
 fever, transient lymphadenopathy or
hypersensitivity reaction might occur following
an MMR vaccination

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VARICELLA (Chickenpox) VACCINE AND ZOSTER HOME-BASED CARE OF AN INFECTIOUS PERSON
(Shingles) VACCINE 1. Reducing Risk to the
 Varicella-zoster is the virus that causes  Patient Equipment Care
chickenpox and herpes zoster  disinfection and aseptic technique while
 Transmission: droplet and airborne and contact using medical equipment. Watch out
routes. for Catheter-related sepsis (redness,
 Incubation period: 2 weeks; newly infected swelling, or drainage around a
 host is already infectious during the prodromal catheter insertion site) for a patient
stage, with rare exception, varicella infects a who has unexplained fever
person only once
 When all lesions crusted, the patient is no  Patient Education
longer contagious  intrinsic colonizing bacteria and latent
 Herpes zoster, also known as shingles, is a viral infections present a greater risk
painful, localized rash caused by recurrent than do extrinsic environmental
varicella with vesicles restricted to areas contaminants
supplied by single associated nerve groups  home needs to be clean but not sterile
 The vaccine should not be given to those:  restrict visits of people with potentially
 pregnant contagious illnesses
 severely depressed immune function  follow recommendations for hygiene,
 have moderate or severe concurrent storage, and safe cooking times and
illnesses, allergy to varicella vaccine temperatures
 Zostavax vaccine is recommended for 60 yo.
2. Reducing Risk to Household Members
INFLUENZA VACCINE  Education about strategies to reduce their
 an acute viral respiratory disease that risk of infection Food preparation and
predictably and periodically causes worldwide personal hygiene (hand washing)
epidemics known as pandemics  Establishing reasonable barriers to infection
 vaccine is given as an injection with inactivated transmission in the household
virus or as a nasal spray with live attenuated  Public health agency coordination for
virus and reduces the risk of illness from flu by screening and treatment
50% to 60% overall  Physical separation from an
 advantageous in preventing hospitalization for immunosuppressed family member
children, those with diabetes or pulmonary (varicella) Using common household
disease, and those over the age of 50. disinfectants in controlling environmental
contamination (enteric organism infection)
HUMAN PAPILLOMAVIRUS VACCINE (HPV)  Proper collection and disposal of sharps and
 HPV is the most prevalent of all sexually waste (blood-borne infection).
transmitted viruses and is the principal cause of
cervical cancer WHAT ARE ISOLATION PRECAUTIONS?
 Vaccination at age 11 or 12 is recommended for  Isolation precautions are guidelines created to
both males and females and are given in a 3- prevent transmission of microorganisms in
dose series hospitals.
 not recommended for those with history of
hypersensitivity to any vaccine component, PREVENTION OF INFECTION IN THE HOSPITAL
those with a history of anaphylactic latex The CDC recommends two tiers of isolation
allergy, or for women who are pregnant. precautions:
1. STANDARD PRECAUTION (First tier)
 is designed for the care of all patients in the
hospital and is the primary strategy for
preventing HAIs

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  all patients are colonized or infected with C. CONTACT PRECAUTIONS
microorganisms, whether or not there are  used for organisms that are spread by skin-
s/s, and that a uniform level of caution to-skin contacts, such as antibiotic-
should be used in the care of all patients resistant organisms
 HCW should use additional barriers  patient is placed in a private room to
depending on the expected degree of facilitate hand hygiene and decreased
exposure to patient excretions or environmental contamination
secretions.  Masks are not needed, and doors do not
need to be closed
2. TRANSMISSION-BASED PRECAUTIONS (Second  Examples are:
tier)  Clostridium difficile
 is designed for the care of patients with  Skin infections
known or suspected infectious diseases  Impetigo
spread by:  cellulitis, or pressure ulcers
 Airborne  Pediculosis
 Droplet  Scabies
 Contact routes  Viral conjunctivitis

TRANSMISSION- BASED PRECAUTIONS

PREVENTION OF INFECTION IN THE HOSPITAL
A. AIRBORNE PRECAUTIONS 1. Specific Organisms with Nosocomial Infection
 negative air pressure, rapid turnover of Potential Nosocomial Infection Potential
 air, and air either highly filtered or A. Clostridium Difficile
exhausted directly to the outside B. Methicillin-resistant Staphylococcus Aureus
 HCW should wear an N95 respirator (MRSA)
 Examples are: C. Vancomycin-resistant enterococcus (VRE).
 Measles
 Varicella 2. Prevention of Bloodstream Infections
 Tuberculosis A. Bacteremia (bacterial infection in the
bloodstream)
B. DROPLET PRECAUTIONS B. Fungemia (fungal infection in the
 can be transmitted by close contact with bloodstream).
respiratory or pharyngeal secretions
 HCW wear a facemask within 3 to 6 feet of Clostridium Difficile
the patient; the door may remain open  is a spore-forming bacterium that has
because the risk of transmission is limited significant HAI potential
to close contact  Infection is usually preceded by antibiotic
 Examples are: agents that disrupt normal intestinal flora and
 Influenza allow the antibiotic-resistant C. difficile spores
 meningitis to proliferate within the intestine releasing
 pneumonia toxins into the lumen of the bowel the resulting
 epiglottitis destruction of such a large anatomic area
 Diphtheria causing sepsis
 Mumps  Control is best achieved by using:
 Rubella  contact precautions
 Streptococcal A pharyngitis  hand hygiene
 scarlet fever  Bleach-based cleaning products
 Disinfection of frequently touch equipment
(IV poles, charts)

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Methicillin-resistant Staphylococcus aureus (MRSA) NURSING DIAGNOSIS
 a common human pathogen, refers to S. aureus  Knowledge deficit about the disease and risk
that is resistant to methicillin or its comparable for spread of infection and reinfection
pharmaceutical agents, oxacillin, and nafcillin  Anxiety related to anticipated stigmatization
 HCW transmits MRSA to patients easily because S. and to prognosis and complications
aureus has an affinity for skin colonization and  Noncompliance with treatment
later on infection especially when invasive
procedures, such as IV therapy, respiratory NURSING INTERVENTIONS/ IMPLEMENTATION
therapy, or surgery, are performed
 INCREASING KNOWLEDGE AND PREVENTING
 The patient who is colonized also serves as a
THE SPREAD OF DISEASE
reservoir for MRSA transmission to others and
 causative organism
may persist as normal flora in the patient for an
extended time.  usual course of the infection, interval of
potential communicability to others)
Vancomycin-resistant Enterococcus (VRE) possible complications.
 This gram-positive bacterium, which is part of the  adherence to therapy as prescribed and
normal flora of the gastrointestinal tract, can  report any side effects or symptom
produce significant disease when it infects blood, progression
wounds, or the urinary tract  REDUCING ANXIETY
 HCW transmits MRSA to patients easily because  encouraged to discuss anxieties and fear
its normal part of the gastrointestinal flora of the associated with the dx, treatment, or
host so is able to withstand harsh anatomic sites, prognosis.
such as the intestine; and it persists well on the  individualized education, factual
hands of health care providers and on  information applied to specific needs may
environmental objects
offer reassurance
 Because many strains of VRE are resistant to all
 INCREASING ADHERENCE
other antimicrobial therapies, clinicians are left
with few choices for effective therapy.  one-to-one setting, open discussion about
disease information facilitates patient
PREVENTION OF BLOODSTREAM INFECTIONS education.
 Any vascular catheter can serve as the source of  Referrals to appropriate agencies can
bloodstream infection. Vascular catheters are  complement individual educational efforts
used for most hospitalized patients, and and ensure that later questions or
increasingly, long-term central catheters are used uncertainties can be addressed by experts
to provide IV therapy to outpatients in a clinic or
home setting. In all instances, the nurse must use WHAT IS EID/ RE-EMERGING INFECTIOUS DISEASES?
appropriate care to reduce the risk of bacteremia  Human diseases of infectious origin that have
and to be alert to signs of bacteremia increased within the past two decades or that
are likely to increase in the near future (Zika
NURSING PROCESS: The Patient with an infectious virus, West Nile Virus, Ebola Virus)
disease
ZIKA VIRUS
ASSESSMENT  was first discovered as a pathogen in monkeys
 obtain history to establish the likelihood and in the Zika Forest of Uganda in the 1940s and
probable source of infection as well as the was found to cause human disease in the 1950s
degree of associated pathology and symptoms  Transmission: bites of infected mosquitos from
 physical examination to reveal signs of the Aedes genus and pass through sexual
infection at any body site: transmission
 Chronic diseases - significant weight loss,  Incubation period: few days
pallor  Clinical presentation:
 Acute infection - fever, chills, rash, or  self-limiting illness of 2 to 7 days duration
lymphadenopathy, Localized signs of  mild fever, rash, headache, conjunctivitis, or
infection joint and muscle pain

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  Associated with microcephaly and other FACTORS THAT CONTRIBUTE TO EID
congenital abnormalities in infants of some  Travel, globalization of food supply and central
women infected with Zika during pregnancy processing of food, population growth,
 Can cause Guillain–Barré syndrome, a increased urban crowding, population
condition with nerve and muscle weakness that movements, ecologic changes, human behavior
often quickly progresses to a paralysis. antimicrobial resistance, and breakdown in
public health measures
WEST NILE VIRUS
 was first recognized in the 1930s in Africa and
was first seen in humans in the United States
in 1999
 Transmission: bites of infected mosquitos,
transplacental, breastfeeding, BT
 Reservoir: birds and organ donors
 Incubation period: between 3 and 14 days
 Clinical presentation:
 headache, fever, and persistent fatigue that
may continue for several months and some
pts develop more serious disease, which is
characterized by severe neuroinvasive
illness, meningitis, encephalitis, and
paralysis or poliomyelitis
 Management consists of fluid replacement,
airway management, and supportive nursing
care

EBOLA VIRUS
 first human outbreak of Ebola virus disease
occurred in 1976 with a sporadic pattern of
outbreaks in remote African villages and went
into rampaged through the West African
countries in 2014
 Transmission: direct contact with blood or body
fluids and handling infected animals hunted for
food
 Incubation period: from exposure to 2 to 21
days. If no symptoms by 21 days
 after exposure, no risk of developing Ebola
 Clinical presentation: high fever, muscle aches,
and fatigue, develops severe diarrhea,
abdominal pain, and vomiting, neurologic
symptoms, bleeding or hemorrhage
 Management: contact tracing, supportive
maintenance of the circulatory system and
respiratory systems (ventilator and dialysis -
acute phase).