Chapter 23: Care of Patients with Infection
A microorganism capable of producing disease.
Transmitted from person to person.
Microorganisms with differing levels of pathogenicity (ability to cause disease) surround everyone.
A term for pathogenicity, is related more to the frequency with which a pathogen causes disease (degree of communicability) and its ability to invade and damage a host.
Microorganisms that are often pathogenic may be present in the tissues of the host and yet not cause symptomatic disease because of normal flora.
Centers for Disease Control and Prevention (CDC)
Collects information about the occurrence and nature of infections and infectious diseases.
Infection Control Practitioner (ICP)
Is responsible for tracking infections (surveillance) and ensuring compliance with federal and local requirements and accreditation standards.
Transmission of Infectious Agents Three Factors:
- Reservoir (or source) of infectious agents
- Susceptible host with a portal of entry
- Mode of transmission
Sources of infectious agents, include people, animals, and insects, soil, water, other environmental sources, and medical equipment.
One who harbors an infectious agent without active disease.
Is resistance to infection; it is usually associated with the presence of antibodies or cells that act on specific microorganisms.
Is of short duration (days or months) and either natural by transplacental transfer from the mother or artificial by injection of antibodies.
Lasts for years and is natural by infection or artificial by stimulation of the body's immune defenses.
Respiratory Tract Route
Microbes in droplets are sprayed into the air when people with infected oral or nasal tissues talk, cough, or sneeze.
GI Tract Route
Some stay there and produce disease, others invade to produce local and distant infection.
Genitourinary Tract Route
Urinary tract infection (UTI) is one of the most common health care–associated infections
Bacteria in the bloodstream
Methods of Transmission
- Contact transmission (indirect and direct)
- Droplet transmission
- Airborne transmission
Is the usual mode of transmission of most infections.
Direct Contact Transmission
The source and host have physical contact, often called person-to-person transmission.
Indirect Contact Transmission
The transfer of microorganisms from a source to a host by passive transfer from a contaminated object.
Are produced when a person talks or sneezes, they travel short distances.
Occurs when small particles enter the air containing pathogens leave the infected source and enter a susceptible host.
Physiologic Defenses for Infection
- Body tissues
- Immune systems
Intact skin forms the first and most important physical barrier to the entry of microorganisms.
Occurs when a foreign substance evades the first-line mechanical barriers and enters the body.
Occurs when tissue becomes damaged.
The antibody-mediated system produces antibodies directed against certain pathogens. These antibodies inactivate or destroy invading microorganisms as well as protect against future infection from that microorganism.
Health Care–Associated Infection (HAI).
Acquired in the inpatient health care setting (not present or incubating at admission).
From a patient's flora
From outside the patient, often from the hands of health care workers, tubes, or implants
Methods of Infection Control and Prevention
- Hand hygiene
- Standard Precautions
- Transmission-Based Precautions
- Staff and patient placement and cohorting
Refers to both washing and alcohol-based rubs
Destroying all living organisms and bacterial spores.
Does not kill spores and only ensures a reduction in the level of disease-causing organisms.
Based on the belief that all body excretions, secretions, and moist membranes and tissues, excluding perspiration, are potentially infectious.
Personal Protective Equipment (PPE)
Refers to gloves, isolation gowns, face protection (masks, goggles, face shields), and powered air purifying respirators (PAPRs) or respirators.
Used for patients known or suspected to have infections transmitted by the airborne transmission route.
Used for patients known or suspected to have infections transmitted by the droplet transmission route.
Used for patients known or suspected to have infections transmitted by direct contact or contact with items in the environment.
Having enough nurses is an essential method for preventing infection.
The placement of patients has been used as a way to reduce the spread of infection.
The practice of grouping patients who are colonized or infected with the same pathogen.
Limiting movement to other areas of the facility, using appropriate barriers like covering infected wounds, and notifying other departments or agencies who are receiving the patient about the necessary precautions.
Which statement by a nursing student indicates a need for further teaching by the nurse regarding infection control for a client who has an open, draining wound?
“I will wear a mask each time I enter the client's room.”
Also called glycocalyx, is a complex group of microorganisms that functions within a “slimy” gel coating on medical devices.
Staphylococcus Aureus (S. aureus)
A common bacterium found on the skin and perineum and in the nose of many people.
Health Care–Associated MRSA, or HA-MRSA
Organism enters into deep wounds, surgical incisions, the lungs, or bloodstream, more serious infections occur that require strong antibiotics like methicillin.
Community-Associated MRSA, or CA-MRSA
Causes infections in healthy, nonhospitalized people, especially those living in college housing and prisons.
A client is admitted with a catheter-associated methicillin-resistant Staphylococcus aureus (MRSA) infection. Which personal protective equipment is appropriate when providing client care? Select all that apply.
Vancomycin-Resistant Enterococcus (VRE)
Are bacteria that live in the intestinal tract and are important for digestion.
Carbapenem-Resistant Enterobacteriaceae (CRE)
Most often given for abdominal infections such as peritonitis, have been used extensively for the past 15 years.
Occupational Safety and Health Administration (OSHA)
A federal agency that protects workers from injury or illness at their place of employment.
Deliberate failure to take the drug
Accidental failure to take the drug
Insufficient cardiac output is compounded by hypovolemia.
Enlarged lymph nodes
Isolation of the pathogen by cultivation in tissue cultures or artificial media.
Antimicrobial Sensitivity Testing
Is performed to determine the effects of various drugs on that particular microorganism.
Is performed to identify pathogens by detecting antibodies to the organism.
Are often given to reduce fever
Hypothermia blankets or ice bags or packs can be effective mechanisms for reducing a high fever.
Reinfection or a second infection of the same kind
C. Difficile–Associated Disease (CDAD)
Spread by indirect contact with inanimate objects like medical equipment and commodes, and its toxins cause colon dysfunction and cell death from sepsis.
Which statement about handwashing is in accordance with recommendations by the Centers for Disease Control and Prevention?
Handwashing must be done after contact with the client’s intact skin, such as when taking a pulse.
While in the hospital, the client has developed a methicillin-resistant infection in the foot. The client had undergone surgical débridement for gangrene. Which precaution is best for this client?
Wear a gown and gloves to prevent contact with the client or client-contaminated items.
Which intervention is the most appropriate to address the priority problem of feelings of isolation when caring for a client who is placed on Transmission-Based Precautions?
Provide education on the mode of transmission of infection.
A client who was treated last month for a bad case of bronchitis and walking pneumonia reports many of the same symptoms today. Which factor in the client’s antibiotic therapy most likely caused the client’s relapse?
Taking the antibiotic most days
Which precaution is best for the nurse to take to prevent the transmission of Clostridium difficile infection?
Wear gloves when contact with body secretions or body fluids is expected.
Which client is at greatest risk for developing an infection?
A 65-year-old woman who had coronary bypass surgery 4 days ago.
Which information does the nurse include when teaching a client about antibiotic therapy for infection?
Take all antibiotics as prescribed, unless side effects develop.
Which is a common clinical manifestation of infectious disease?
A 14-year-old client has severe fatigue, swollen glands, and a low-grade fever. Which blood test result is used to confirm a diagnosis of mononucleosis?
Decreased neutrophil count
Which statement about the transmission of hepatitis C is correct?
Equipment or linen soiled with blood or body fluids should be washed with bleach or a disinfectant to prevent infection.
Which statement about why multidrug-resistant organisms and other infections are increasing in incidence is correct?
Antibiotics have been given to clients for conditions that do not require antibiotics.
Which nurse does the charge nurse assign to care for a 64-year-old client who has pneumonia and requires IV antibiotic therapy and IV fluids at 200 mL/hr?
A float RN with 7 years of experience on the inpatient oncology unit.
The nurse manager for a long-term care facility is in charge of implementing a plan to decrease the spread of infection within the facility. Which part of the plan is most appropriate to delegate to nursing assistants working at the facility?
Reinforcing the need for handwashing after caring for clients.
A priority problem of hyperthermia is identified by the long-term-care RN who is caring for a client with a urinary tract infection. Which intervention is most appropriate to delegate to a nursing assistant?
Increase fluid intake by assisting the client to choose approved and preferred beverages.
Which actions aid in the prevention and early detection of infection in a client at risk? (Select all that apply.)
- Promote sufficient nutritional intake.
- Obtain cultures as needed.
- Remove unnecessary medical devices.