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Immune system

Pathogenicity ability to produce disease (potency)
Pathogen microorganism that causes disease
Opportunistic pathogen only susceptible hosts
Asepsis absence of disease-causing microbes
The infectious agent can be transmitted by direct or indirect contact or by airborne particles Communicable Disease
Infectious diseases are a major cause of death worldwide Communicable Disease
Limits the number, growth, and transmission of microorganisms Medical Asepsis
Clean (almost all organisms absent ) Medical Asepsis
Dirty (organisms likely to be present) Medical Asepsis
Practices that destroy all microorganisms and spores Surgical Asepsis
Sterile Technique Surgical Asepsis
Sepsis—whole body inflammatory process, resulting in acute illness Surgical Asepsis
Generally referred to as state of infection Surgical Asepsis
Opportunistic pathogens cause disease only in susceptible host
True pathogen causes disease or infection in healthy individual
Bacteria Most common; several hundred species can cause disease in humans
Viruses consist mostly of nucleic acids and cannot reproduce unless they enter living cells. (hepatitis, rhinovirus, herpes, HIV)
Fungi yeasts and molds (candida)
Parasites live on other living organisms;
Protozoa (malaria),
Helminths (worms),
arthropods (mites, fleas, ticks).
Transported via air, water, food, soil, body tissues & fluid, & inanimate objects (fomites)
Septicemia is bacteremia that results in a systemic infection
Acute infections generally appear suddenly & last a short time
Chronic infections develop slowly over long period of time, and may last months or years
bacteremia In systemic infection, blood culture reveals microorganisms
do not normally cause disease during colonization Resident flora grow and multiply in host
Systemic Infection organisms spread and damage different parts of body
Local infection limited to parts of body where microorganisms remain
Colonization process where microorganisms become resident flora
infection Can cause disease if host defenses ineffective (or organisms out of balance
Etiologic agent (microorganism) The chain of infection chain 1
Reservoir (source) The chain of infection chain 2
Portal of exit from reservoir The chain of infection chain 3
Method of transmission The chain of infection chain 4
Portal of entry to the susceptible host The chain of infection chain 5
Susceptible host The chain of infection chain 6
Depends on virulence, potency of microorg., ability to enter body, susceptibility of host, and the ability to live in the body. Smallpox highly virulent; TB less so. Etiologic agent (microorganism)
Humans and their environment most common sources to self & others; a carrier is someone who shows no s/s but can pass on the organism (ex. Flu) Reservoir (source)
Nose/mouth, feces, urine, wounds Portal of exit from reservoir
Break in the skin is most common, or airborne c. diff spores; may enter by same route as it left the source. Portal of entry to the susceptible host
Decreased immunity–immunocompromised--(CA or transplant) and age (young and old) Susceptible host
touch, bite, kiss, sex, or droplet within 3 ft of source of sneeze, cough, spit, etc Method of transmission direct
has to have a vehicle {object that transfers germs such as a toy} or a vector {animal or insect}) vs. airborne (floats in the air by spray or dust such as TB) Method of transmission indirect
Vascular & Cellular Responses Inflammatory Response
Exudates Production Inflammatory Response
Reparative Phase Inflammatory Response
Intact skin and mucous membranes: 1st line of defense Barriers That Defend Against Infection
Moist mucous membranes and cilia of the nasal passages trap dust and particulates Barriers That Defend Against Infection
Oral cavity—saliva inhibits microbial invaders Barriers That Defend Against Infection
Alveolar macrophages: phagocytes devour bacteria and viruses Barriers That Defend Against Infection
Tears: clean eyes of debris Barriers That Defend Against Infection
High acidity of the stomach: Kill bacteria Barriers That Defend Against Infection
Urine flow through the urethra: Washes out organisms such as e- coli Barriers That Defend Against Infection
Nursing Interventions that Break Chain of Infection Specific to each link Hand Cleansing Hygiene Preventing ideal environment for growth Limiting exposure & transmission Education-Client Teaching , Infection Control,
Low pH of the vagina 3.5-4.5, prevents bacterial growth in warm moist place. ↑ pH and sweetness from diabetes increase infection rate (especially fungal)
Peristalsis moves microorganisms out
Normally body’s defenses protect Nonspecific defenses anatomic, physiological, inflammatory response
Normally body’s defenses protect Specific defensess immune system (antibodies vs. specific antigens)
Intact skin, mucous membranes First line of defense
Host susceptibility Affected by many factors
Age for immature immunity newborns
Age for immunity becomes weak elders
Nutritional status especially if protein reserves depleted
Medical therapies radiation therapy, biopsies
Medications cancer meds, steroids, antibiotics killing normal flora and allowing overgrowth of pathogens
Pre-existing Diseases that lower body’s defenses COPD, PVD, DM, protein wasting, ↓immunity
Heredity immunoglobulin deficiency
Physical, emotional stressors- ↑cortisone; prolonged ↑causes ↓immune response
Antiseptics chemical preparations that inhibit growth of some microorganisms. Used on skin or tissue.
Disinfectants chemicals that destroy pathogens other than spores. Used on inanimate objects. More concentrated solution than antiseptics.
Bactericidal Agent destroys bacteria
Bacteriostatic Agent prevents growth, reproduction of some bacteria
Disinfecting and Sterilizing Etiologic agent and reservoir interrupted
Supporting Defenses of a Susceptible Host Susceptibility  degree to which a person can be affected
Recommended concentration of disinfectant, duration of contact Nursing Considerations When Disinfecting
Type and Number of Organisms Nursing Considerations When Disinfecting
Presence of soap can inhibit action Nursing Considerations When Disinfecting
Presence of organic materials (saliva, blood, pus, excretions)—can inactivate disinfectants Nursing Considerations When Disinfecting
Surface area to be treated—must cover entire affected area Nursing Considerations When Disinfecting
Sterilization Destroys all microorganisms, including spores & viruses
Sterilization Moist heat autoclave, steam under pressure
Sterilization Gas ethylene oxide, kills spores, good for heat sensitive objects, toxic to humans
Sterilization Boiling water at least 15”, doesn’t kill spores & some viruses
Sterilization Radiation UV not deeply penetrating; Ionizing good for heat sensitive objects, foods, drugs, but expensive
Standard Precautions—used in care of all hospitalized persons regardless of diagnosis or possible infection status
Transmission-Based Precautions Avoid injury from sharp instruments, prevent exposure, communicate precautions to employees
Droplets are smaller than 5 microns (measles, TB, and varicella) Airborne
Pts need a private room with negative pressure air Airborne
Special respirator mask Airborne
Pt must be transported with a mask on the patient Airborne
Protective Isolation Compromised clients—highly susceptible to infections—from their own flora or other people or objects
leukemia Protective Isolation Example
chemotherapy Protective Isolation Example
burns Protective Isolation Example
severe dermatitis Protective Isolation Example
transplant patients Protective Isolation Example
Contact Precautions Intended to prevent transmission of infectious agents, including epidemiologically important microorganisms, which are spread by direct or indirect contact with the patient or the patient's environment
Particle Droplets greater than 5 microns Droplet Precautions
Diphtheria Droplet Precautions disease
Pneumonic plague Droplet Precautions disease
Scarlet fever (infants & young children) Droplet Precautions disease
Strep pharyngitis Droplet Precautions disease
Rubella Droplet Precautions disease
Mycoplasma pneumonia Droplet Precautions disease
Pertussis Droplet Precautions disease
All objects used in sterile field must be sterile Sterile Field
Sterile objects become unsterile when touched by unsterile objects Sterile Field
Sterile items out of vision or below waist or table level are considered unsterile. Sterile Field
Sterile objects can become unsterile by prolonged exposure to airborne microorganisms Sterile Field
Sterile field microorganism-free area, supplies in wrappers
NIOSH part of CDC, preventing needlesticks
OSHA protect healthcare workers from injuries
Report the incident immediately: Identify and document the source Bloodborne Pathogen Exposure
Test the source for Hep B, C and HIV (with consent) Bloodborne Pathogen Exposure
Seek appropriate evaluation and follow-up Bloodborne Pathogen Exposure
Post exposure prophylaxis if indicated (with HIV, must begin within 1 hour of exposure) Bloodborne Pathogen Exposure Seek appropriate evaluation and follow-up
Medical and Psychological counseling Bloodborne Pathogen Exposure Seek appropriate evaluation and follow-up
Puncture/Laceration Encourage bleeding, but do not squeeze tissues
Incubation Stages of the infectious process
Prodromal Stages of the infectious process
Acute—max. impact Stages of the infectious process
Convalescent Stages of the infectious process
Carrier Stages of the infectious process
host defenses eliminate disease, but organism still replicates on mucosal sites Carrier
pathogen actively replicates but does not cause symptoms yet—hrs. (Salmonella) to years Incubation
nonspecific symptoms begin (malaise, fever, myalgias, headache, fatigue) Prodromal
rapid proliferation and dissemination of microorganism; symptoms worse, tissue damage and inflammation Acute—max. impact
infection contained; pathogen gone Convalescent
Specific to infecting organisms, body systems involved Complications of infectious diseases-
Shock, hypotension, impaired organ perfusion Complications of infectious diseases-
Diffuse cell & tissue injury; potential organ failure Complications of infectious diseases-
Urinary Tract Most common HAI; gram negative septicemia
Respiratory Tract Pneumonia 2nd most common HAI—ventilators, trachs, ET intubation
Invasive catheter sites on skin bacteremia from intravascular and urinary catheters
Surgical Wounds staph, enterococcus, including MRSA, VRE
Endogenous Source of microorganisms
Exogenous Source of microorganisms
Iatrogenic Source of microorganisms
Source of microorganisms -from client Endogenous
Source of microorganisms -hospital and staff Exogenous
Source of microorganisms - diagnostic/therapeutic Iatrogenic
HAIs —after 48 hours of hospitalization Health care-associated infections
Nosocomial Infections 2 million clients how many deaths 90,000
VRE methicillin resistant Staph Aureus
MRSA Vancomycin resistant Enterococcus
Penicillin resistant Strep. pneumonia (PRSP)
C. difficile common cause of nosocomial diarrhea
MDR-TB Multi-drug-resistant Tuberculosis
VISA or VRSA Vancomycin-resistant or –intermediate S. aureus
Prevent infection 1 of the 4 strategies from CDC to prevent Antimicrobial Resistance in Healthcare Settings
Diagnosing and treating infection effectively 1 of the 4 strategies from CDC to prevent Antimicrobial Resistance in Healthcare Settings
Using antimicrobials wisely 1 of the 4 strategies from CDC to prevent Antimicrobial Resistance in Healthcare Settings
Preventing transmission 1 of the 4 strategies from CDC to prevent Antimicrobial Resistance in Healthcare Settings
Antibodies pass from mother to baby through the placenta or in colostrum- lasts 6 mo to a year Natural passive immunity
When the immune serum (antibody) from human or animal is injected – lasts 2-3 weeks (IVIG) Artificial passive immunity
Passive Immunity Host receives natural or artificial antibodies produced from another source
Active Immunity Host produces antibodies in response to natural antigens or artificial antigens
(Have had the disease) Antibodies form in the presence of infection, lifelong immunity Natural active immunity
(Vaccines) Antigens administered stimulate antibody formation, lasts for years – reinforced by booster Artificial active immunity
Fever Signs of Systemic Infection: SEPTICEMIA
Tachycardia and tachypnea Signs of Systemic Infection: SEPTICEMIA
Malaise Signs of Systemic Infection: SEPTICEMIA
Anorexia, nausea and vomiting Signs of Systemic Infection: SEPTICEMIA
Lymphadenopathy Signs of Systemic Infection: SEPTICEMIA
Localized swelling Signs of Localized Infection: BACTEREMIA
Localized redness Signs of Localized Infection: BACTEREMIA
Pain or tenderness with palpation or movement Signs of Localized Infection: BACTEREMIA
Palpable heat in the infected area Signs of Localized Infection: BACTEREMIA
Loss of function of the body part affected Signs of Localized Infection: BACTEREMIA
Localized Infection- Skin and mucous membranes (swelling, redness, pain, heat, loss of function, wound drainage)
Signs of systemic infection (Fever, ↑pulse, resps., malaise, fatigue, ↓appetite, N, V, ↑lymph nodes)
Created by: ED.
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