Professional Documents
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Infection Control in Nursing
Infection Control in Nursing
Microorganisms exist everywhere: in water, in soil, and on body
surfaces such as the skin, intestinal tract, and other areas open to the
outside such as our mouth, upper respiratory tract, vagina, and lower
urinary tract. Many organisms are harmless, others are lethal, and some
are a normal part of our body. As such, the ones directly involved in
providing a biologically safe environment are none other than the
nurses.
What is Infection?
Infection is the growth of microorganisms in body tissue where they are not
usually found.
Disease- A detectable alteration in normal tissue
function is called disease.
Virulence- Microorganisms vary in their virulence or their
ability to produce disease, the severity of the diseases
they produce, and their degree of communicability.
Infectious agent- such a microorganism is called
an infectious agent, or the source, a germ, a virus or
other microbes.
Medical asepsis- includes all practices intended to
confine a specific microorganism to a specific area,
limiting the number, growth, and transmission of
microorganisms.
Pathogenicity- is the ability to produce disease; thus, a
pathogen is a microorganism that causes disease.
Asepsis- is the freedom from disease causing
microorganism; aseptic technique is used to decrease the
possibility of transferring microorganisms from one
place to another.
Sepsis-is the condition in which acute organ dysfunction
occurs secondary to infection.
Surgical asepsis- or sterile technique refers to those
practices that keep an area or an object free of all
microorganisms; it includes practices that destroy
microorganisms and spores.
Types of Microorganisms
Four major categories of microorganisms cause infection in humans:
bacteria, viruses, fungi, and parasites.
Types of Infection
Infection occurs when newly introduced or resident microorganisms succeed
in invading a part of the body where the host’s defense mechanisms are
ineffective and the pathogen causes tissue damage.
Bloodstream- The most common bloodstream microorganisms
include coagulase-negative staphylococci (inadequate
hand hygiene), Staphylococcus
aureus and Enterococcus species (improper intravenous
fluid, tubing, and site care technique).
Pneumonia- The most common causative microorganisms
for pneumonia include Staphylococcus aureus (inadequate
hand hygiene), Pseudomonas
aeruginosa and Enterobacter species (improper suctioning
technique).
Urinary tract- The most common microorganisms in the
urinary tract include Escherichia
coli (improper catheterization technique), Enterococcus
species (contamination of closed drainage system),
and Pseudomonas aeruginosa (inadequate hand hygiene).
Surgical sites- The most common microorganisms in surgical
sites include Staphylococcus
aureus including MRSA (inadequate hand
hygiene), Enterococcus species including vancomycin-
resistant strains (improper dressing change technique),
and Pseudomonas aeruginosa.
Chain of Infection
Reservoir-Reservoirs are sources of microorganisms;
common sources are other humans, the client’s own
microorganisms, plants, animals, or the general
environment; a carrier is a person or animal reservoir
of a specific infectious agent that usually does not
manifest any clinical signs of the disease.
Etiologic agent- The extent to which any microorganism is
capable of producing an infectious process depends on
the number of microorganisms present, the virulence and
potency of the microorganisms, the ability of the
microorganisms to enter the body, the susceptibility of
the host, and the ability of the microorganisms to live
in the host’s body.
Portal of exit from reservoir- Before an infection can establish
itself in a host, the microorganisms must leave the
reservoir; common human reservoirs include respiratory
tract, GI tract, urinary tract, reproductive tract,
blood, and tissues.
Method of transmission-After a microorganism leaves its
source or reservoir, it requires a means of transmission
to reach another person or host through a receptive
portal of entry; there are three mechanisms: direct
transmission, which involves immediate and direct
transfer of microorganisms from person to person through
touching, biting, kissing, or sexual
intercourse; indirect transmission may be
either vehicle-borne (any substance that serves as an
immediate means to transport and introduce an infectious
agent into a susceptible host through a suitable portal
of entry) or vector-borne (an animal or flying or
crawling insect that serves as an intermediate means of
transporting an infectious agent); airborne
transmission may involve droplets or dust such as a
droplet nuclei (the residue of evaporated droplets
emitted by infectious host such as someone
with tuberculosis, can remain in the air for long
periods
Portal of entry to susceptible hosts-Before a person can become
infected, microorganisms must enter the body; often,
microorganisms enter the body of the host by the same
route they used to leave the source.
Susceptible host- A susceptible host is any person who is
at risk for infection; a compromised host is a person at
increased risk, an individual who for one or more
reasons is more likely than others to acquire an
infection.
Inflammatory Response
Inflammation is a local and nonspecific defensive response of the tissue to
an injurious or infectious agent; it is an adaptive mechanism that destroys or
dilutes the injurious agent, prevents further spread of the injury, and
promotes the repair of damaged tissue.
Specific Defenses
Specific defenses of the body involve the immune system; the immune’s
response has two components: antibody-mediated defenses and cellular-
mediated defenses.
Nursing Management
Nursing management for infection control includes the following:
Nursing Diagnosis
Based on the assessment data, the most appropriate nursing diagnosis are:
Implementation
The nurse prevents strategies to prevent infection.
Preventing nosocomial infections- Meticulous use of medical
and surgical asepsis is necessary to prevent the
transport of potentially infectious microorganisms.
Standard Precautions
Standard precautions are used in the care of all hospitalized individuals
regardless of their diagnosis and possible infection status.
Transmission-based Precautions
Transmission-based precautions are used in addition to standard precautions
for clients with known or suspected infections that are spread in one of
three ways: by airborne or droplet transmission, or by contact.
Antibody-Mediated Defenses
Another name for the antibody-mediated defenses is humoral (or
circulating) immunity because these defenses reside ultimately in the
B lymphocytes and are mediated by antibodies produced by B cells.
Cell-Mediated Defenses
The cell-mediated defenses, or cellular immunity, occur through the T-cell
system.
There are three main groups of T-cells: helper T cells, cytotoxic T
cells, and suppressor T cells.
On exposure to an antigen, the lymphoid tissues release large numbers
of activated T-cells into the lymph system.
These T-cells pass into the general circulation.
Helper T cells-help in the function of the immune system.
Suppressor T cells-suppress the functions of the helper T
cells and cytotoxic T cells.
Cytotoxic T cells-attack and kill microorganisms and
sometimes the body’s own cells.
Airborne Precautions
Use standard precautions as well as the following:
Wear an N95 respirator mask when entering the room of a
client who is known to have or suspected of having
primary tuberculosis.
Limit movement of clients outside the room to essential
purposes; place a surgical mask on the client during
transport.
Susceptible people should not enter the room of a client
who has rubeola (measles) or varicella (chicken pox).
Place client in an airborne infection isolation room
that has negative air pressure, 6 to 12 air changes per
hour, and either discharge of air to the outside or
a filtration system for the room air.
If a private room is not available, place the client
with another client who is infected with the same
microorganism.
Contact Precautions
Use standard precautions as well as the following:
Sterile Technique
An object is sterile only when it is free of all microorganisms.
Sterile technique is also employed for many procedures in
general care areas such as when administering injections,
changing wound dressings, performing urinary
catheterization, and administering intravenous therapies.
In these situations, all principles of the surgical asepsis
are applied as in the operating or delivery room; however,
not all of the sterile techniques that follow are always
required.
It is well known that sterile technique is practiced in
operating rooms and special diagnostic areas.