MSALI: INFECTIONS

Terms■Pathogens■Host■Colonization■Reservoir■Causative Agents■Bacteria ■Aerobic■Anaerobic■Mode of Transmission■Portal of Entry

■Portal of Exit■Fungi■Virus■Protozoa■Helminths■Prions■Human Body’s Defense

Mechanisms■Sepsis

Infection Control in Health-Care Agencies

■Community-acquired Infection■Nosocomial Infection or

Hospital – Acquired (HAI)■Hand Hygiene

Nosocomial Infections■Medicare implemented a policy on October 1, 2008

that penalizes hospitals if Medicare patients acquire any of 8 conditions during their inpatient stay

■3 of these conditions are infections:■ Catheter-Associated Urinary Tract Infection (UTI)■ Vascular Catheter-Associated Infection■ Surgical Site Infections, various

Nosocomial Infections

■Infection from Stay in Health-care Agency

■Risk Factors– Host’s Condition– Multiple Antibiotic Therapy – High-risk Units

Nosocomial Infections (cont’d)

■Common Pathogens– Escherichia coli (E. coli) – Staphylococcus aureus – Pseudomonas aeruginosa

Hand Hygiene

■Before and After– Patient

Contact– Glove Use

Local vs. Systemic Infections

■Local

■Pain, redness, swelling, warmth at site

■ Systemic

■ Headache, malaise, fever, anorexia, aches.

■ Can progress to hypotension, tachycardia, mental confusion

Gram Positive Bacteria

Medications to Treat Infectious Diseases■Table 8.3

■Nursing responsibilities:■Note all patient allergies■Obtain culture samples before initiating

antibiotic treatment■Monitor and report all side effects■Observe for s/s of superinfections

Antibiotic Resistant Infections

Who Is At Risk?■Severe and/or prolonged illness■Persons with comorbidities – especially chronic

renal disease, diabetes mellitus, peripheral vascular disease, skin lesions

■Previous exposure to antimicrobial agents■Invasive procedures – such as dialysis,

invasive devices, urinary cauterization, surgery

■Repeated contact with HC system■Previous colonization of MDRO■Advanced Age

MRSA■Methicillin Resistant staphylococcus

aureus■- a bacteria

■Common sites :– Nares– Skin

Colonized

Treatment■I & D■Contact ISO Precautions

■Clindamycin■Tetracyclines■Rifampin■Linezolid■Bactrim■Mupirocin ointment for topical tx

Prevention

■Hand Hygiene

■Decolonization

Decolonization

■Mupirocin ointment for nares

■Use of daily chlorhexidine baths in ICU ■populations may decrease overall rates of ■bloodstream infections and MRSA ■acquisition, but effect on MRSA infections ■less clear

VRE

■Vancomycin-resistant Enterococci

■- a bacteria

■normally present in the human intestines and in the female genital tract and are often found in the environment.

What types of infections does VRE cause?

■It can cause infections of the urinary tract, the bloodstream, or of wounds associated with catheters or surgical procedures.

Who is at RISK?■People who have been previously treated

with the antibiotic vancomycin or other antibiotics for long periods of time.

■People who are hospitalized, particularly when they receive antibiotic treatment for long periods of time.

■People with weakened immune systems.■People who have undergone surgical

procedures.■People with medical devices that stay in for

some time such as urinary catheters or central intravenous (IV) catheters.

■People who are colonized with VRE.

Treatment

■People who are colonized do not usually need treatment.

■Most VRE infections can be treated successfully with antibiotics other than vancomycin.

■Laboratory testing of the VRE sample can determine which antibiotics will successfully treat the infection.

Clostridium difficile Infection

■A spore-forming, Gram-positive anaerobic bacillus

■The bacteria are found in the feces.

■Associated with ABX use.

S/S of Clostridium difficile infection?

■watery diarrhea (at least three bowel movements per day for two or more days)

■fever■loss of appetite■nausea■abdominal pain/tenderness

The risk for disease increases in patients with:

■antibiotic exposure■proton pump inhibitors■gastrointestinal surgery/manipulation■long length of stay in healthcare settings■a serious underlying illness■Immuno-compromising conditions■advanced age

Treatment

■The infection can usually be treated with an appropriate course of antibiotics,

■including metronidazole, vancomycin , or recently approved fidaxomicin.

■Fecal Transplant

■Contact Isolation - Healthcare workers and visitors must use gloves and gowns on entry to a room of a patient with CDI.

■Emphasize compliance with the practice of hand hygiene.

Community Acquired Infections

■An infection acquired outside health care settings, such as in the home or in the community.

Communicable Diseases

■See Handout

Influenza

■Influenza viruses are spread from person to person primarily through large-particle respiratory droplet

transmission (e.g., when an infected person coughs or sneezes near a

susceptible person).

■The typical incubation period for influenza is 1—4 days (average: 2 days)

■Most healthy adults may be able to infect others beginning 1 day before symptoms develop and up to 5 to 7 days after becoming sick

S/S

■fever, myalgia, headache, malaise, nonproductive cough, sore throat, and rhinitis

Occurrence

Diagnostics

■Preferred respiratory samples for influenza testing include nasopharyngeal or nasal swab, and nasal wash or aspirate, depending on which type of test is used .

■Samples should be collected within the first 4 days of illness.

■Rapid influenza diagnostic tests provide results within 20 minutes or less; viral culture provides results in 3-10 days

Prevention – FLU Vaccination – for residents and employees■Flu vaccines cause antibodies to develop in the

body about two weeks after vaccination. These antibodies provide protection against infection with the viruses that are in the vaccine.

■The seasonal flu vaccine protects against the influenza viruses that research indicates will be most common during the upcoming season.

Treatments■Three antiviral drugs recommended by the

CDC & approved by the FDA:oseltamivir (brand name Tamiflu®), zanamivir (brand name Relenza®) and peramivir (brand name Rapivab®). Tamiflu® comes as a pill or liquid, and Relenza® is an inhaled powder. (Relenza should NOT be used in anyone with breathing problems, like asthma or COPD, for example.) Rapivab® is administered intravenously.

Complications

■Dehydration■Pneumonia■Change in Mental status

Nursing Diagnoses

■Fluid Volume, deficient■Activity Intolerance■Risk for Injury■Impaired Comfort■Risk for Ineffective Breathing