Week 3 (Monika) Management of Patients With Infectious Diseases

Question 1

Chain of Infection

Answer 1

• A complete chain is necessary for infection to occur
• Causative organism
• A reservoir of available organisms
• A portal of exit from the reservoir
• A mode of transmission from the reservoir to the host
• Mode of entry into a susceptible host
• Susceptible host

Question 2

Chain of Infection

Answer 2

• Causative organism
• Bacteria
• Viruses
• Fungi
• Helminths & protozoa
• Reservoir
• any person, plant, animal, substance, or location that provides
nourishment for microorganisms and enables it to disperse

Question 3

Chain of Infection

Answer 3

• Portal of exit from the reservoir: host sheds organism through:
• respiratory tract, GI tract, GU tract, or blood.
• A mode of transmission from the reservoir to the host
• may be transmitted through sexual contact, skin-to-skin
contact, percutaneous injection, or infectious particles
carried in the air.
• Specific organisms require specific routes of transmission for
infection to occur

Question 4

Chain of Infection
• Susceptible host

•
• Mode of entry into a susceptible host
•

Answer 4

Chain of Infection
• Susceptible host
• Lacks immunity to a specific pathogen
• Immunocompromised
• Mode of entry into a susceptible host
• Specific organisms may require specific portals of entry for
infection to occur.

Question 5

Colonization, Infection, and Disease
• Colonization:

Answer 5

• Describes microorganisms present without host
interference or interaction
• A patient colonized with Staphylococcus aureus may have
staphylococci on the skin without any skin interruption or
irritation

Question 6

Colonization, Infection, and Disease
• Infection:
• Infectious disease:
•

Answer 6

Colonization, Infection, and Disease
• Infection: indicates host interaction with the organism
• Break in skin allows organism to enter host
• Infectious disease:
• the infected host displays a decline in wellness caused by
the infection

Question 7

Infection Control and Prevention

Answer 7

• World Health Organization (WHO)
• Centers for Disease Control and Prevention (CDC)
• CDC publications, guidelines, and website
• Occupational safety and health administration (OSHA)
• Mandatory regulations and guidelines
• Local agencies
• Hospital and facility infection control specialists and facility policies

Question 8

Isolation Precautions

Answer 8

• Guidelines to prevent the transmission of microorganisms in
the healthcare setting
• Two tiers:
• Standard precautions: all patients
• The primary strategy for preventing HAIs
• Transmission-based precautions: for patients with known
infectious diseases spread by airborne, droplet, contact
routes

Question 9

Standard Precautions

Answer 9

• Hand hygiene
• Use of gloves and other barriers
• Proper handling of patient care equipment and linen
• Environmental control
• Prevention of injury from sharp devices and needles
• Patient placemen

Question 10

Transmission-Based Precautions

Answer 10

• Airborne precautions
• Negative pressure room
• N-95 respirator
• TB, varicella, anthrax, other airborne pathogens

Question 11

Transmission-Based Precautions
• Droplet precautions
•

Answer 11

Used for organisms transmitted by close contact with
respiratory or pharyngeal secretions:
• influenza, meningococcus, PNA
• Wear a face mask but door may remain open
• transmission is limited to close contact

Question 12

Transmission-Based Precautions

Answer 12

• Contact precautions
• Used for organisms spread by skin-to-skin contact
• Use of barriers to prevent transmission
• Organisms are easily transmitted by contact between the
health care worker and the patient
• Masks not needed
• Antibiotic-resistant organisms or Clostridium difficile

Question 13

Transmission-Based Precautions

Answer 13

• Enhanced Precautions
• Goggles or face shield
• N-95 mask
• Gown
• Gloves

Question 14

Organisms of HAI Infection Potential

Answer 14

• Clostridium difficile (C. difficile or C.Diff.)
• S/P ABX
• Most common cause of HAIs
• Spore-forming

Question 15

Organisms of HAI Infection Potential

Answer 15

• Methicillin-resistant S. aureus (MRSA)
• Colonization versus infection
• HA-MRSA
• Linked to invasive procedures
• CA-MRSA
• Added toxins leading to skin infections

Question 16

MRSA Treatment

Answer 16

• Vancomycin
• drug of choice for treating most MRSA infections
• Also:
• clindamycin
• co-trimoxazole
• fluoroquinolones
• minocycline

Question 17

Organisms of HAI Infection Potential

Answer 17

• Vancomycin-resistant enterococcus (VRE)
• Combinations of vancomycin, gentamicin and/or linezolid
• Multidrug-resistant organisms (MDROs)
• Various antibiotics depending on sensitivity

Question 18

Prevention of Infection

Answer 18

• HAI bloodstream infections: CLABSI Bundle
• Optimal catheter site selection
• Hand hygiene –sterile technique for insertion
• Maximal barrier precaution
• Chlorhexidine skin anti-sepsis
• Daily review of line necessity

Question 19

Emerging Infectious Disease

Answer 19

• Zika virus
• Primarily transmitted through bites of infected mosquitos
• Associated with microcephaly and other congenital
abnormalities in infants after mother infected during pregnancy
• May be transmitted through sexual transmission
• West Nile virus
• primarily transmitted through bites of infected mosquitos
• Both treated for symptoms only

Question 20

Emerging Infectious Diseases

Answer 20

• Ebola viral disease
• Transmitted through direct contact with body fluid,
infected wild animals
• Treated by circulatory support (monoclonal antibodies,
ventilator, dialysis)
• Legionnaires disease
• Transmitted by the aerosolized route
• ABX: azithromycin, doxycycline, or a fluoroquinolone

Question 21

Emerging Infectious Diseases

Answer 21

• COVID
• Transmitted during close contact by airborne transmission
(airborne particles and droplets)
• Remdesivir, dexamethasone
• Supportive care

Question 22

Controls to Address Emerging Infectious Diseases

Answer 22

• Vaccination programs
• More than 50 vaccines licensed in the United States
• MMR, varicella, influenza, HPV, COVID
• Planning for a pandemic
• Global outbreak of disease
• H1N1, Asian avian influenza (H5N1)
• SARS, MERS, COVID

Question 23

Sexually Transmitted Infections

Answer 23

• Most common infectious disease in the United States
• Syphilis
• Chlamydia trachomatis
• Neisseria gonorrhea
• Dual therapy for chlamydia recommended
• human immune deficiency virus (HIV)
• Sites of infection:
• Skin and mucosal lining of urethra, cervix, vagina, rectum,
oropharynx

Question 24

Sexually Transmitted Infections

Answer 24

• Routes
• Sexual
• Percutaneous
• Perinatal
• See Table 71-3

Question 25

Sexually Transmitted Infections: Assessment

Answer 25

• Protect confidentiality
• Communication needs to be
• Culturally and emotionally sensitive
• Factual
• Matter of fact

Question 26

Sexually Transmitted Infections: Assessment

Answer 26

• “Five P’s”:
• Partners – are you active, sex of partner
• Prevention of pregnancy – birth control, future plans
• Protection from STIs – are you using protection, do you get
tested
• Practices – what kind of sex are you having
• Past history of STIs – diagnosed in the past

Question 27

Sexually Transmitted Infections: Symptom Assessment

Answer 27

• Frequently asymptomatic until advanced
• Physical examination
• Rashes, lesions, drainage, inguinal nodes, genitalia, rectal,
mouth and throat;
• Women assessed for abdominal and uterine tenderness
HIV-related complication (PNA, TB, Cytomegalovirus)

Question 28

STI Potential Complications

Answer 28

• Women
• Pelvic Inflammatory Disease (PID)
• Ectopic pregnancy
• Transmission of infection to fetus
• Stunting of growth, deafness, etc.
• Men
• Epididymitis (swollen, red or warm scrotum, painful testes)

Question 29

STI Interventions

Answer 29

• Education about STDs and the spread & treatment of infection
• Reducing anxiety
• Encourage open discussion
• Provide factual information
• Involve partners in discussion
• Referral to a social worker
• Increasing adherence
• Patient education in group or individual settings
• Referral to appropriate agencies

Question 30

Diarrheal Diseases

Answer 30

• Port of entry is oral ingestion
• Causes
• Bacterial; Campylobacter, Salmonella, Shigella, E. coli
• Viral; Rotavirus and Calicivirus (Norovirus)
• long-term care facilities and cruise ships
• Parasitic; Giardia and Cryptosporidium

Question 31

Infectious Diarrhea – Clinical Manifestations

Answer 31

• History: recent travel, use of antibiotics, food intake,
• Hydration status:
• Thirst
• Dry mucous membranes
• Weak pulse
• Loss of skin turgor
• Sunken eyes
• I&O

Question 32

Infectious Diarrhea—Interventions

Answer 32

• Maintenance of fluid and electrolyte balance
• Increase knowledge about disease and risk for transmission
• Absence of complications

Question 33

Correction of Dehydration

Answer 33

• Oral rehydration best
• ORS (oral rehydration salts)solution
• Pedialyte, sports drinks okay
• Mild Dehydration
• Dry mucous membranes and increased thirst
• Rehydration goal 50 mL/kg over 4 hours

Question 34

Correction of Dehydration

Answer 34

• Moderate Dehydration
• Sunken eyes, poor skin turgor, increased thirst, dry mucous
membranes
• Rehydration goal 100 mL/kg over 4 hours
• Severe Dehydration
• Signs of shock (rapid thready pulse, cyanosis, cold extremities,
rapid breathing, lethargy, or coma)
• IV replacement until hemodynamic and mental status return to
normal then treat oral solutions

Question 35

Increasing Knowledge and Prevention of Spread

Answer 35

• Food preparation
• Hygiene
• Standard precautions