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