Week 3 (Monika) Management of Patients With Infectious Diseases Flashcards
Chain of Infection
• 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
Chain of Infection
• 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
Chain of Infection
• 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
Chain of Infection
• Susceptible host
•
• Mode of entry into a susceptible host
•
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.
Colonization, Infection, and Disease
• Colonization:
• 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
Colonization, Infection, and Disease
• Infection:
• Infectious disease:
•
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
Infection Control and Prevention
• 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
Isolation Precautions
• 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
Standard Precautions
• 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
Transmission-Based Precautions
• Airborne precautions
• Negative pressure room
• N-95 respirator
• TB, varicella, anthrax, other airborne pathogens
Transmission-Based Precautions
• Droplet precautions
•
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
Transmission-Based Precautions
• 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
Transmission-Based Precautions
• Enhanced Precautions
• Goggles or face shield
• N-95 mask
• Gown
• Gloves
Organisms of HAI Infection Potential
• Clostridium difficile (C. difficile or C.Diff.)
• S/P ABX
• Most common cause of HAIs
• Spore-forming
Organisms of HAI Infection Potential
• Methicillin-resistant S. aureus (MRSA)
• Colonization versus infection
• HA-MRSA
• Linked to invasive procedures
• CA-MRSA
• Added toxins leading to skin infections
MRSA Treatment
• Vancomycin
• drug of choice for treating most MRSA infections
• Also:
• clindamycin
• co-trimoxazole
• fluoroquinolones
• minocycline
Organisms of HAI Infection Potential
• Vancomycin-resistant enterococcus (VRE)
• Combinations of vancomycin, gentamicin and/or linezolid
• Multidrug-resistant organisms (MDROs)
• Various antibiotics depending on sensitivity
Prevention of Infection
• 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
Emerging Infectious Disease
• 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
Emerging Infectious Diseases
• 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
Emerging Infectious Diseases
• COVID
• Transmitted during close contact by airborne transmission
(airborne particles and droplets)
• Remdesivir, dexamethasone
• Supportive care
Controls to Address Emerging Infectious Diseases
• 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
Sexually Transmitted Infections
• 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
Sexually Transmitted Infections
• Routes
• Sexual
• Percutaneous
• Perinatal
• See Table 71-3
Sexually Transmitted Infections: Assessment
• Protect confidentiality
• Communication needs to be
• Culturally and emotionally sensitive
• Factual
• Matter of fact
Sexually Transmitted Infections: Assessment
• “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
Sexually Transmitted Infections: Symptom Assessment
• 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)
STI Potential Complications
• 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)
STI Interventions
• 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
Diarrheal Diseases
• 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
Infectious Diarrhea – Clinical Manifestations
• History: recent travel, use of antibiotics, food intake,
• Hydration status:
• Thirst
• Dry mucous membranes
• Weak pulse
• Loss of skin turgor
• Sunken eyes
• I&O
Infectious Diarrhea—Interventions
• Maintenance of fluid and electrolyte balance
• Increase knowledge about disease and risk for transmission
• Absence of complications
Correction of Dehydration
• 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
Correction of Dehydration
• 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
Increasing Knowledge and Prevention of Spread
• Food preparation
• Hygiene
• Standard precautions
