Week 7 Infection Control Flashcards
Isolation Precautions: Contact Precautions
- PPE: gloves and Gown
Examples: VRE, MRSA, Scabies, Lice, large non-contained draining wounds
Contact Precautions: Droplets
- PPE: gloves, gown, mask
Examples: necrotizing fasciitis, certain PNA’s, influenza
Contact Precautions: Airborne
- PPE: gloves, gown, special mask, negative pressure room
Examples: Tuberculosis, measles
Clean Technique
- Standard technique using boxed not sterile gloves
- intended to reduce or prevent transmission of miscroorganisms from one location to another
Sterile Technique
- Not warranted for most wound care
- Used for:
Immunocompromised patients
severe burns
Large surface area wounds
Packing deep wounds
Only sterile equipment contacts patients wounds
Bacteria Shapes
Cocci = circular
Spirilla = spiral shaped
Bacilli = rod shaped
Bacteria Reproduction
Either divide into:
Chains= strept
or
Clusters = staphly
Bacterial Staining
- Important to know for which antibiotic to use
- Gram positive = stains with crystal violet and secrete exotoxins that can cause extensive damage (these ones suck ass don’t like them :( )
- Gram negative= Stained by saffron that excretes less damaging exotoxins
Bacteria Growth Environment
Aerobic = requires oxygen to grow
Anaerobic= does not require oxygen to grow Example: the GI tract
Methicillin-resistant Staphylococcus Aureus (MRSA)
- Can live hours to days on surfaces
- Spreads easily
- Can cause cellulitis, osteomyelitis, abscess
- Treatment with Mupirocin
- Resistant to a lot of antibiotics
- Common in blood and stool wounds
Vancomycin- Resistant Enterococci (VRE)
- Treated with ampicillin amoxicillin
- Hard bacteria to get rid of
- More common in surgical wounds and urine
Pseudomonas Aeruginosa
- Gram negative anaerobe
- “Sickly sweet” odor
- Often in wounds
- Green drainage
Fungal
- Tinea- ring worm
- Candida- yeast
What are Biofilms?
- a cluster of bacteria or fungi that is held together by a self produced polymer matrix
- Very hard to kill
- Persist on medical devices, surfaces, and tissues causing chronic infection
- generally found on devitalized tissues, implanted devices, and within gastric mucosa
- Can survive in environments where they normally could not
- Redevelop quickly
True or false: Biofilms keeps wounds in the inflammatory phase oh healing which can cause damage to cells and proteins needed to heal
True
Biofilm in (blank) of acute wounds but up to (blank) of chronic wounds
6%
60%
Normal Microbes in wounds are
- Contamination= microbes non-replicating
- Colonization= replicating microbes; just not enough to become an infection
Critical Colonization
- Bioburden reaches a critical point and begins to adversely affect host
- Different loads affect people differently
- No standard number for critical colonization
- When wound goes from colonized to infected
- Healthy people may be able to tolerate a higher bioburden then someone who is malnourished or immune compromised
Infection is
- Healthy Tissue starts to become damaged
- Replicating microbes invade viable body tissue
- No cut off point for infection because some bacteria in low concentrations can cause huge infections and vice versa some large loads of bacteria may nor cause an infections
Why do microbes cause problems?
- Compete with host cells for available oxygen and nutrients
- Bacteria exotoxins may be cytotoxic which also kill good cells
- Bacteria endotoxins may activate host inflammatory process
- Wound infections delay and may prevent wound healing ; wound that is infected will cause the wound to stay in the inflammatory state and the endotoxins will be contributing to that state
(Endotoxins are molecules in the walls of bacteria which can cause fever, clotting or bleeding depending on the bacteria)
Characteristics of Inflammation
- Rubor= Well defined erythemal border and proportionate to size and extend of the wound
- Calor= local increase in temperature
- Tumor= slight swelling/proportionate
- Dolor= proportionate to the type of wound and extent of tissue damage
- Functio Laesa= Temporary (loss of function)
- Drainage= proportionate to size, extent, and diagnosis: thin consistency: Serous or serosanguinous
- Decline in wound= With appropriate management, follow normal phase of healing
Characteristics of Infection
- Rubor= Poorly defined erythemal boarder: Disproportionate: May possess red streaks leading out from the wound
- Calor= Patient may be febrile (fever): Warmer localized tissue temperature spreading over a wider surface area
- Tumor= Disproportionate to size and extent off wound: May be indurated
- Dolor= New onset or increased pain
- Fuctio Laesa = Malaise, feel ill
- Drainage = Disproportionate amount may be copious: Creamy thick or purulent consistency : white, yellow, green , or blue : may have a distinctive color
- Plateau in healing: change in granulation tissue (less friable, change in color)
Silent Abscesses
- Abscess= localized collection of pus, that body can contain but not fight completely
- Abscesses can be internal so you will not see the signs of infection
* Arterial insufficiency can’t mount fight due to inadequate blood flow so signs of infection are not expresses: may not see the classic signs of infection with someone who has arterial insufficiency*
Local Risk factors for Infection
- Ischemia= Don’t have enough oxygen or immune fighters so you are at a higher risk for infection
- Necrotic Tissue= breeding ground for bacteria allows it to grow easily
- Wound debris = if not cleaned out it can cause infection
- Chronic wounds= open for long periods of time then more bacteria has time to get there
Host factors for Infection
- Break in skin integrity
- Diabetes
- Malnutrition
- Obesity
- Steroid Use
- Immunocompromised
- Increased age
Wound Cultures
- Cultures confirm the presence or absence of infection
- Swab cultures are used to quantify numbers and type of bacteria
-GOLD STANDARD= Tissue biopsy - Fluid aspiration for abscesses
- Blood test= identify microbes by presence of serum antibodies
Creams Topically for wound infection
- last 8-12 hours
- Antimicrobial agents destroy unicellular organisms
Antimicrobial Ointments
- 8-24 hours
Iodine for Infections and wounds
Iodine usually is cytotoxic which means it kills everything
Silver Containing Dressings for Infections
- can be used to treat aerobically, anaerobic, Gram positive and negative bacteria
Topical honey for Infections
- may assist in controlling wound bioburden
- regularly used in wound care
Antibiotics: Bactericidal
destroy
Antibiotics: Bacteriostatic
Inhibit cell growth
Antifungals
fight yeast, mold
- some are only for intact skin while other are for wounds
Debridement for wound infections
- Removes infected tissue= used to prevent infection by removing necrotic tissue that facilitates bacterial growth
Antiseptic Vs. Antimicrobial
- Antiseptic= antimicrobial that is cytotoxic meaning the good and the bad are killed
- Antiseptics should be used to disinfect inanimate objects or for ashes for intact skin
Antibiotic Misuse
- Prescribed without infection present
- 50% deemed unnecessary
- Wrong antimicrobial prescribed
- Taken incorrectly
Which is more severe of an adverse drug reaction topical agents or systemic use?
systemic use
True/ False: Patients with venous insufficiency tend to have more reactions to topical antimicrobials
True
How to prevent infection?
- Hand washing
- Standard/universal precautions
- Manage medical conditions known to increase risk of wound formation
- Proper patient positioning
- Proper skin care
- Proper foot care
- Cost
