Infection Prevention & Control

Question 1

Infection VS. Colonization

Answer 1

• Infection: invasion of susceptible host by pathogens or microorganisms ⇒ entry and multiplication of organisms ⇒ results in disease
• Colonization: when microorganism invades but doesn’t cause infection ⇒ where culture is positive w/ no S&S of infection

Question 2

Natures of infection: symptomatic, asymptomatic, communicable disease - contagious disease, noncommunicable disease

Answer 2

• Symptomatic: if pathogens multiple and cause clinical S&S of infection
• Asymptomatic: clinical S&S of infection aren’t present
• Communicable disease: infectious process transmitted from one person to another (ie. covid)
  
  • Contagious disease: easily spreads from one person to another
• Noncommunicable disease: disease not transmitted from one person to another
  
  • Ie. cancer, heart failure

Question 3

4 Stages of Infectious Process

Answer 3

• Incubation Period: once pathogen is in host’s body → incubation period begins
• Prodromal Stage: Feeling run-down & Showing some vague S&S (Phase when you’re starting to show some of the illnesses S&S)
• Illness Stage: No denying the illness & Feeling specific S&S of disease
• Convalescence: Phase where they don’t have active Sx of disease but still has residual S&S
  
  • Can linger for yrs and is different for everyone

Question 4

Defenses Against Infection: Inflammation

Answer 4

• Body’s first line of defense when injury occurs, not actually a bad thing
• Vascular and cellular responses: body sending blood and oxygen to injury site ⇒ promotes healing + sends WBC to engulf pathogens that may be present
• Exudates: after WBC traps bacteria, they produce exudates
  
  • Can be clear ⇒ serous
  • Can tinged with pink ⇒ serous sanginous
  • Really bloody ⇒ sanguineous
  • WBC containing bacteria and looking white/yellow ⇒ Purulent (has foul odor)
• Tissue repair: body’s way of imitating previous cells and trying to repair ⇒ trying to build back and cover what was injured so that no further pathogens can get in

Question 5

Chain of Infection

Answer 5

• Infectious agent or pathogen
• Reservoir or source of pathogen growth
• Portal of exit
• Mode of transmission
• Portal of entry
• Susceptible host

Question 6

Types of HAIs: Iatrogenic, Exogenous, Endogenous

Answer 6

• Iatrogenic: from diagnostic procedure/nosocomial
  
  • Can also occur from use or overuse of broad-spec antibiotics
  • Ie. pt went to get bronchoscopy and got infection
• Exogenous: comes from microorganisms outside the individuals
  
  • Ie. foodborne illness salmonella
• Endogenous: when part of pt’s flora becomes altered and overgrowth occurs

Question 7

Types of Infections: Local

Answer 7

• Point or area of contact
• Fever
• Heat
• Pain
• Pus
• Redness/inflammation
• Foul odor/discharge

Question 8

Types of Infections: Systemic

Answer 8

• Toxin in bloodstream
• VS changes: hypotension, tachycardia (!!!), tachypnea
• Fatigue/weakness
• Chills
• Body aches
• Fever
• N/V
• General malaise
• Dehydration

Question 9

Monitoring Lab Tests

Answer 9

• WBC w/ differential: 12+ is concerning & below 3/4 is concerning !!!
  
  • Neutrophils: baby cells that can be rapidly increased in infection bc body is trying to produce as many as possible to fight pathogen and is concerning bc they’re fighting infection even as immature cells when they’re not supposed to
  • Lymphocytes: ↑ more in chronic infections
  • Monocytes: ↑ in presence of tuberculin and protozoan infections
  • Eosinophils: ↑ in parasitic infections
  • Basophils: usually normal in infections but elevated in allergic rxns
• ESR: means there’s some type of inflammatory process happening
• Hepatic dysfunction: bilirubin or INR – ↑ in infections bc body’s organs can start failing
• Creatinine: kidneys affected by infection
• Lactate lvls: concerning bc body is undergoing lactic acidosis
  
  • Want it less than 1.2 !!! otherwise can indicate Systemic inflammatory response syndrome (SIRS) or septic shock
• Hyperglycemia: bacteria and virus love sugar + healing process slows ⇒ pt becomes sicker
• Iron lvls: reduced in chronic infections
• Cultures: urine, blood, sputum, stool, wound

Question 10

Sepsis S&S

Answer 10

• Sepsis: defined as at least 2 of following S&S of…
• Hyperthermia >38.3C or Hypothermia <36
• Tachycardia: >90 bpm
  
  • Unless baseline is 90 then you should be monitoring for sepsis even though norm HR taught is 60-100 !!!
• Leukocytosis or Leukopenia
• ALOC: altered LOC
• Tachypnea: >20 bpm
• Hyperglycemia >120 w/o DM

Question 11

Severe sepsis definition & S&S

Answer 11

• includes SIRS + one of following S&S of…
• Hypotension: late sign of sepsis and means you missed something or they’ve been sick for awhile now
  
  • If you’ve waited until their BP is low then you’ve waited too long !!!
• Mottled skin/cap refill >3 sec
• DIC: pt is bleeding
• Decreased Urinary Output (UOP): sign of worsening kidney dysfunction
• Lactate >2: means pt is undergoing lactic acidosis
• Renal/Hepatic dysfunction
• Acute Lung Injury (ALI) or Acute Respiratory Distress Syndrome (ARDS)
• Cardiac dysfunction: arrhythmias, HF S&S, etc.

Question 12

Standard precautions (tier 1)

Answer 12

• used for care of all pts, in all settings regardless of risk and presumed infectious status !!!
• Assumes all pts are potentially infectious
• Applies to blood, blood products, body fluids, secretions/excretions, non-intact skin, mucous membranes
• Sometimes referred to as body substance or universal precautions

Question 13

Transmission-Based Precautions (tier 2)

Answer 13

• Isolation precautions: for airborne, droplet, contact, and protective environment (neutropenia, reverse isolation)
• Isolation environment is clean/safe
• PPE Sequence donning & doffing properly !!!
• Specimen collection properly
• Bagging trash or linen appropriately
• Pt transportation: pt wears mask and nurse doesn’t wear PPE or gloves bc those aren’t allowed in hallways so notify target transport area of disease type, where it’s located, etc. !!!

Question 14

Airborne

Answer 14

• Private, negative-pressure airflow room w/ doors closed
• Pt leaves room for only essential clinical reasons & wearing surgical mask
• Ie. TB, shingles, chickenpox, COVID-19

Question 15

Droplet

Answer 15

• Private room, may cohort w/ same active infection
• Surgical mask required when working 3-6 ft of pt
• Ie. diphtheria, meningitis, respiratory illnesses, COVID-19

Question 16

Contact Precaution

Answer 16

• Private rooms, may cohort w/ same active infection
• Gloves & gown
• Dedicated equipment for pt only
• Contact plus: traditional handwashing, bleach wipes used on equipment, disposable equipment only
• Ie. MRSA, C. diff, scabies, herpes, rash

Question 17

Neutropenic Precautions

Answer 17

• For immunocompromised pts where we protect them from us !!!
• Limit visitors & all visitors must be well w/ no signs of illness
• Staff follows strict hand hygiene protocol and wears surgical mask when in pt’s room
• Neutropenic diet: no raw/uncooked meat, no salads, fruits/vegetables needs to be thoroughly cooked or washed, distilled/bottled/filtered water preferred, no unpasteurized dairy
• No live plants or flowers in pt’s room
• Signage on door explaining precautions and positive airflow room

Question 18

When to wash hands?

Answer 18

• When hands are visibly dirty/soiled
• Before eating
• After using toilet
• If exposed to spore-forming organisms (ie. C. diff)

Question 19

If hands not visibility soiled →

Answer 19

• use alcohol based waterless antiseptic agent
• before/after/between pt contact
• after contact w/ body fluids and excretions
• when moving from contaminated to non-contaminated body site
• after leaving pt’s room
• before entering pt’s room
• before/after putting on gloves or inserting invasive devices
• before putting on sterile gloves
• after contact w/ surfaces or objects in pt’s room