UNIT-VII

INFECTION
CONTROL
 INFECTION
• Infection is the entry & multiplication of an
organism (infectious agent) in a host.

• Infection is the growth of microorganism in body

tissue where they are not usually found .such
organism are called infectious agents .

• An infection is a disease state that results from the

presence of pathogens in or on the body.

• A detectable alteration in normal tissue function

is called disease
•VIRULENCE is the ability of the organism to produce
disease .ie the ability of pathogen to multiply within host

•if the infectious agents can be transmitted to an

individual by direct or indirect contact or as an airborne
transmission ,the resulting condition is called
COMMUNICABLE DISEASE.

• PATHOGENICITY is the ability to produce disease ,thus

PATHOGEN is a organism that causes disease.
•True pathogen -cause disease in an healthy host .
•Opportunistic pathogen - cause disease in susceptible
host.
• ASEPSIS : is the freedom from disease causing
organism .
• Two basic type of asepsis are used :
• MEDICAL ASEPSIS
• SURGICAL ASEPSIS
• Medical asepsis includes all practices intended
to remove specific organism from specific area
limiting the number growth and transmission .
And objects are considered as clean or dirty.

SURGICAL ASEPSIS : or sterile technique are refers

to those practices that destroy all
microorganism and pores
NATURE OF INFECTION {types of
infection}
• COLONIZATION
If a microorganism is present or invades a host ,
grow or multiplies but does not cause infection is
referred to as colonization

When the culture of the persons blood reveals

microorganism :BACTEREMIA .
When bacteremia results in systemic infection it
is known as SEPTICEMIA.
Infections are infectious or communicable
•Infectious Disease
The illness possibly serious for the client,
does not pose a risk for transmission to others
including caregivers
e.g: viral meningitis , pneumonia

•Communicable Disease
If the infectious agent (disease ) can be
transmitted to an individual by direct or indirect
contact or as an airborne infection
 SYMPTOMATIC OR ASYMPTOMATIC
• Symptomatic
If the pathogens multiply & cause clinical signs &
symptoms, the infection is symptomatic

• Asymptomatic or Subclinical
If the microorganism produces no clinical
evidence of disease the infection is called
asymptomatic or subclinical.
 TYPES OF INFECTIONS
• Local infection
It is limited to the specific part of the
body where the microorganisms remain.
• Systemic infection
If the microorganisms spread & damage
different parts of the body, the infection is
systemic infection
• Bacteremia
When a culture of the person’s blood
reveals microorganisms , the condition is
called bacteremia. It may be transient or
sustained.

• Septicemia
When sustained bacteremia results in
systemic infection is referred to as septicemia.
 • Acute infection
It generally appears suddenly or last a
short time .

•Chronic infection
It may occur slowly over a very long period
& may last months or years .
• NOSOCOMIAL INFECTION :hospital acquired
infection (HAI) are called nosocomial infection.
•
Infection Cycle
INFECTIOUS AGENT OR ETIOLOGIC
AGENT
• Bacteria
• Viruses
• Fungi
• Protozoa
 INFECTIOUS AGENT
• Bacteria
Categorized acc to shape
• Spherical (cocci)
• Rod shaped (bacilli)
• Corkscrew (spirochetes)

On the basis of staining

• Gram Positive - thick cell wall that resists de-
colorization and are stained violet
• Gram Negative - chemically more complex cell
walls and can be decolorized by alcohol

On the basis of oxygen requirement

• Aerobic and Anaerobic
VIRUS
• Smallest of all organisms
• Causes many infections
including AIDS, and the
common cold
FUNGI
• Plant like organism (mold and yeast) that can
also cause infection.
• Present in soil, air and water.
• Many are resistant to TX
 ORGANISMS
Potential to cause disease depends on
• Number of organisms
• Virulence of the organism
• Competence of persons immune system
• Length of intimacy of the contact
• Normal flora – microorganism that commonly
inhabits various body sites
• Opportunistic – Bacteria that may potentially be
harmful . Escherichia coli cause urinary tract
infection.
RESEVOIR
A reservoir is a place where a pathogen can survive
but may or may not multiply.
• Possible reservoir – human, animals, food , water,
feces, insects & inanimate objects.
• Example..
• Humans –HIV
• Animals – rabies
• Soil – gas gangrene, tetanus
ENVIRONMENT REQUIRED FOR THE MICROORGANISMS
INCLUDES …

•Food
Microorganisms require nourishment
•Oxygen
Aerobic bacteria require oxygen for survival &
multiplication sufficiently to cause disease .
eg: Mycobacterium tuberculosis
Anaerobic bacteria only grow in absence of free
oxygen.eg: clostridium tetani
• Water
Most organism require water for survival
• Temperature
Microorganisms can live only in certain
temperature range . Ideal temperature for most
human pathogens is 20-43 C (68-109 F)
• pH
Most microorganisms prefer an environment with
in a pH range of 7.2 – 7.4.
• Light
It thrive in dark environment .
 PORTAL OF EXIT

• The exit from the reservoir.

• Point of escape for the organism
• It includes sites such as Skin & mucous membrane ,
respiratory tract, GIT, Urinary tract, Reproductive Tract,
blood & transplacental.
Modes of Transmission

Method by which the

pathogen leaves from the
reservoir to the new host
 MEANS OF TRANSMISSION
• DIRECT TRANSMISSION
• INDIRECT TRANSMISSION
1. VEHICLE - BORNE TRANSMISSION -BLOOD, FOOD,
WATER, INANIMATE OBJECTS
2. VECTOR - BORNE TRANSMISSION – MOSQUITOS,
TICKS
• AIRBORNE TRANSMISSION -COUGHING, SNEEZING
Transmission may occur
through:

Direct Contact
air
insects
PORTAL OF ENTRY
• Route through which the pathogen enters its
new host
• May be the same route as they use for
exiting from the prior reservoir
 Respiratory System

n
it o
l a
h a
in
 Gastrointestinal System

n
io
st
ge
in
 Urinary & Reproductive
ac l
nt u a Tracts
t
co x
Se
Breaks in Protective Skin
Barrier
 The Susceptible Host

A susceptible host is any

person who is at risk for infection.

The support of pathogen life &

its reproduction depend on the
degree of the host’s resistance.
STAGES OF INFECTION

• INCUBATION PERIOD
• PRODROMAL STAGE
• ILLNESS STAGE
• CONVALESCENT PERIOD
 INCUBATION PERIOD
• Interval between entrance of pathogen in to
the body and appearance of first signs and
symptoms .
• Example
-Chicken pox(10-21days)
-Common cold(1-2 days)
-Influenza(1-5 days)
-Mumps(12 -26 days)
 PRODROMAL STAGE

• Interval from onset of nonspecific signs and

symptoms (malaise ,low grade fever, fatigue) to
more specific symptoms. During this time
microorganisms grow and multiply , and client
may be capable of spreading to others
• For example-Herpes simplex begins with itching
and tingling at the site before the lesion
appears.
 ILLNESS STAGE

• Interval when client manifests signs and

symptoms specific to type of infection.
• For example-
- Strep throat is manifested by sore throat, pain
and swelling
- mumps is manifested by high fever , parotid
and salivary gland swelling
CONVALESCENT (RECOVERY)
PERIOD
• Interval when acute symptoms of infection
disappear.(Length of recovery depends on
severity of infection and client host
resistance :recovery may take several days to
months)
 BODY’S DEFENSE AGAINST
INFECTION
Nonspecific defenses
1.Anatomic & physiological barriers

2.Inflammatory Response
Stages
1st stage : vascular or cellular response
2nd stage : Exudate production
3rd stage :Reparative phase
SPECIFIC DEFENSES
It involve the immune system.

• Immune response
1. Antibody – mediated defenses or humoral
immunity

a. Active immunity
b. Passive immunity

2. Cell mediated defenses

 FACTORS INCREASING
SUSCEPTIBILITY TO INFECTION
• Age
• Heredity
• Nutritional status
• Preexisting illnesses
• Stress
• Disease process
• Medical therapy
• Invasive devices
NURSING MANAGEMENT

Assessment
1.History Collection
•Immunization status
•Previous or recurring infections
•Nonverbal cues
•Treatment of current disease process
 PHYSICAL ASSESSMENT
Local infection
Localized redness, swelling, pain, tenderness,
heat ,loss of function, drainage from open wound
or lesion
Systemic infection
Fever, increased pulse & respiration, malaise,
loss of energy, anorexia, sometime nausea &
vomiting, enlargement & tenderness of lymph
nodes.
 LABORATORY DATA

Normal values listed are elevated with infection

• WBCs (4,500-11,000/ mm3)
• Neutrophils (60-70%)- acute infection
• Lymphocytes (20-40%)- chronic infection
• Eosinophils (1-4%)- allergic reaction
• Basophil (0.5 %-1 %)-usually unaffected infection
• Erythrocyte sedimentation rate
• Pathogen present in culture
 NURSING DIAGNOSIS
• Risk for infection
• Risk for complication
• Imbalanced nutrition
• Acute pain
• Social Isolation
• Risk for impaired skin integrity
• Anxiety
 OBJECTIVE
• Patient remains free of infection
• Patient maintains or restore defenses
• Patient demonstrates measures to decrease
infection
• Patient verbalizes understanding of infection
prevention & control technique
• Patient maintains normal nutritional status
• Patient verbalizes reduction of pain & anxiety
Breaking the Chain of Infection
 NOSOCOMIAL INFECTIONS

It is an infection that are associated with the delivery of

health care services in a health care facility.
It can either develop during a clients stay in a hospital
or manifest after discharge.
The National Nosocomial infection surveillance (NNIS)
system have revealed that the Urinary tract respiratory
tract, blood stream & wound are the most common
nosocomial infection sites.
Nosocomial / Health Care Acquired
Infections

Exogenous infections –Causative organism of an infection is

acquired from the hospital environment & hospital personnel.

Endogenous infections – Causative organism can originate

from the client themselves.

Iatrogenic infections– Occurs as a result of a therapeutic or

diagnostic procedures.

Most hospital acquired infections are from bacteria

E.g. E.coli, Staphylococcus aureus
Enterococcus species Contamination of closed drainage
system
Pseudomonas aeruginosa
Inadequate hand cleaning
Surgical sites
Staphylococcus aureus Inadequate hand cleaning

Enterococcus species & Improper dressing change

Pseudomonas aeruginosa technique
Blood stream
Coagulase negative
staphylococci Inadequate hand cleaning

Staphylococcus aureus & Inadequate iv fluid tubing &

Enterococcus species site care technique
Pneumonia
Staphylococcus aureus Inadequate hand cleaning
 Prevention Strategies For
Nosocomial Infections
•Infection control committees
•Written infection prevention practices
•Healthy lifestyles
•Proper hand hygiene technique
•Environmental controls
•Sterile technique
•Identification & management of clients at
risk for infection.
 CLEANING AGENTS

• Antiseptic – inhibits the growth of bacteria

• Antibacterial – kill bacteria or suppresses

their growth AKA -antimicrobial
STERILIZATION AND
DISINFECTION
• Disinfection – destroys all pathogenic
organism except spore

• Sterilization – The process by which all

microorganisms including spores are
destroyed
 FACTORS IN SELECTING
METHOD
• Nature of Organism
• Number
• Type of equipment
• Intended use of equipment
• Available means of sterilization
 UNIVERSAL PRECAUTIONS
• Recommended HCW’s to use gloves, gowns,
mask, and protective eyewear when exposure to
blood or body fluids is likely and to consider that
all clients might be potentially infected.
• Blood, semen, vaginal secretions, and p,
cerebrospinal fluid, synovial fluid, pleural fluid,
peritoneal fluid, pericardial fluid, amniotic fluid.
 DO NOT INCLUDE

• Feces, nasal secretions, sputum, sweat, tears,

urine, and vomitus, unless they contain
visible blood
 OSHA – Occupational Safety
And Health Administration
• Guidelines establishes minimum health safety
standards for workers

• 1991 issued regulations for use of universal

precautions in all situations and settings in which
occupational exposures to blood and other
potentially infectious material made violations
punishable with severe fines.

• Requires employers to offer HBV vaccines free of

charge
BODY SUBSTANCE
PRECAUTIONS
• This is an extension
• Considers all body fluids potentially
infected
• Stop sign alert
Current CDC (center for disease
control and prevention)
recommendations

• Standard precautions – precautions used in the care

of all hospitalized persons. Applies to blood, all body
fluids, secretions and excretions except sweat,
nonintact skin, and mucous membranes
• Transmission based precautions – precautions used
in addition to standard precautions for clients in
hospitals with suspected infection with pathogens
that can be transmitted by airborne droplet or
contact routes
MEETING PATIENT NEEDS

• Sensory Deprivation

• Loss of self esteem