INFECTION &
INFLAMMATION
NUR134
Clean hands video
https://www.youtube.com/watch?v=SMjNCiYvDZQ&feature=related
Objectives-found in Leaning
Packet
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1. Explain the key terms in the textbook reading assignment.
2. Examine the infection cycle and evaluate methods to break the chain of infection.
3. Differentiate the stages and characteristics of infection.
4. Discuss nosocomial infections (Health Care Acquired Infections) and the sites they
usually occur.
5. Identify factors that reduce the incidence of Health Care Acquired Infections.
6. Integrate standard precautions during patient care.
7. Differentiate the classifications of pathogens.
8. Explain the body’s normal defense against infection and identify patients at risk for
developing infections.
9. Explain the inflammatory response, including signs and symptoms.
10. Utilize the nursing process to assist in the development of a plan of care/concept map
for the care of patients with infection and inflammation problems.
11. Apply transmission based precautions.
12. Utilize criteria to evaluate patients’ response to nursing interventions.
13. Evaluate the phases of wound healing and the types of repair.
14. Differentiate the roles of the RN and the LPN in the care of patients with infection and
inflammation problems.
15. Review Evidence Based Information in text.
Pre lecture Quiz-True or False
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1. The portal of exit is the point in the chain of
infection in which the organism enters a new host.
2. Bacteria are the smallest of all microorganisms.
3. A person is most infectious during the prodromal
stage of illness.
4. Surgical asepsis, or clean technique, involves
procedures and practices that reduce the number
and transfer of pathogens.
5. Hand hygiene is the most effective way to prevent
the spread of organisms.
Pre Lecture Quiz-Fill in the Blank
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1. The __________________ of a microorganism is the natural
habitat of the organism where growth and multiplication occur.
2. ___________________, such as mosquitoes, ticks, and lice,
are carriers that transmit organisms from one host to another.
3. The _____________________ response helps the body to
neutralize, control, or eliminate an offending agent and to
prepare the site for repair
4. ______________________-based precautions are used for
patients in hospitals with suspected infection with pathogens
that can be transmitted by airborne, droplet, or contact routes.
5. The infection control process of
_______________________destroys all pathogenic organisms,
including spores.
Unfolding Case Study
Clark Austin is a 75 year retired person who lives
with his wife, Ann. He is admitted to the
hospital with acute cholecysitis. He has
undergone a choylstectomy and has been
transferred to your floor 2 days post op. He
has a nasogastric tube to low intermittent
suction, one peripheral line, 20g in Right arm, a
large abdominal dressing and a history of
emphysema. In addition he is on O2 2L/min
per NC, and receives a continuous pulse
oximetry monitoring.
Infection
á
Definition - Disease state
resulting from the
presence of pathogens in
or on the body
Chain of infection
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Infectious agent
Reservoir
Portal of exit
Mode of
transmission
Portal of entry
Susceptible host
http://www.youtube.co
m/watch?v=NHHrCZkcF
Xk
https://www.youtube.com/watch?v=NHHrCZkcFXk
Infectious Agent
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Virulence
Invasiveness
Number present
Ability to live at
body temperature &
cause illness
Examples of agents
http://time.com/79
209/solving-themystery-flu-thatkilled-50-millionpeople/
http://time.com/79209/solving-the-mystery-flu-that-killed50-million-people/
Prevalent Resistant
Organisms
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Methicillin –resistant staphylococcus
aureus (MRSA)
Vancomycin-resistant enterococcus
(VRE)
Aminoglycoside-resistant pseudomonas
(gentamicin, tobramycin, amikacin)
CDC | 12 Steps to Prevent Antimicrobial
Resistance Among Long-term Care Residents
https://www.cdc.gov/antibiotic-use/healthcare/index.html
Reservoir
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Inanimate – soil,
water, other
environmental
sources,
medical equipment
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Animate – people,
animals,
insects
The Inanimate Environment Can
Facilitate Transmission
X represents VRE culture positive sites
~ Contaminated surfaces increase cross-transmission ~
Abstract: The Risk of Hand and Glove Contamination after Contact with a
VRE (+) Patient Environment. Hayden M, ICAAC, 2001, Chicago, IL.
Portal of exit
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Method for the pathogens to
leave the source
–Respiratory tract
–Gastrointestinal tract
–Genitourinary tract
–Breaks in Skin, mucous
membranes
–Bloodstream
Laboratory Data Indicating
Infection
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Elevated white blood cell count—normal
is 5,000 to 10,000/mm3
Increase in specific types of white blood
cells
Elevated erythrocyte sedimentation rate
Presence of pathogen in urine, blood,
sputum, or draining cultures
Means of
transmission
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3 Primary Routes
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Contact -2 modes
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Direct
Indirect
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Droplet
Airbourne
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2 Lesser Routes
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Vehicles
Vector
Isolation guidelines
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A group of actions that include hand hygiene and the use
of barrier precautions, which intend to reduce the
transmission of infectious organisms
Precautions apply to all clients, regardless of diagnosis,
and implementation of them must occur whenever there’s
anticipation of coming into contact with a potentially
infectious material.
Change personal protective equipment after contact with
each client and between procedures with the same client I
in contact with large amounts of blood and body fluids
Clients in isolation are at higher risk for depression and
loneliness. Assist the client and their family to understand
the reason and provide sensory stimulation
Infection control
Standard precautions
(tier one)
 Hand hygiene
 Appropriate gloving and
glove changing
 Masks, eye protection,
face shields if splashing
of body fluids
 Properly clean equipment
 Proper disposal of
trash/laundry
 Sharps precautions
Transmission
precautions (tier two)
 Airborne precautions
 Droplet precautions
 Contact precautions
Aseptic Technique
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Includes all activities to prevent or
break the chain of infection
Two categories
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Medical asepsis—clean technique
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Handwashing/clean gloving – best defense
against infection
Surgical asepsis—sterile technique
% Recovery of gram
negative bacteria
40
Evidence based Practice
Can a Fashion Statement
Harm the Patient?
35
Natural (n=31)
Artificial (n=27)
Polished (n=31)
30
ARTIFICIAL
20
10
10
0
5
POLISHED
NATURAL
p<0.05
Avoid wearing artificial nails, keep natural nails
<1/4 inch if caring for high risk patients (ICU, OR)
Edel et. al, Nursing Research 1998: 47;54-59
Portal of entry
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Respiratory tract
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URI
Gastrointestinal tract
 Genitourinary tract
 Breaks in Skin, mucous
membranes
 Bloodstream
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Susceptible host
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Factors affecting susceptibility
Intact skin and mucous membranes
Normal pH levels
Body’s white blood cells
Age, sex, race, hereditary factors
Immunization, natural or acquired
Fatigue, climate, nutritional and general health status
Stress
Use of invasive or indwelling medical devises
Unfolding Case Study
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What are some characteristics of Mr.
Austin that put him at risk for infection?
Nosocomial infections
(Health Care-Associated Infections)
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Risk Factors
Skin integrity
 Multiple illnesses
 Invasive procedures/indwelling
medical devices
 Broad spectrum antibiotics
 Poor aseptic technique
 Multiple health care personnel
 Extended length of hospitalization
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Causes &
sites
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Urinary Tract
Surgical/traumatic wounds
Respiratory Tract (URI, pneumonia)
Blood stream
Question
Which of the following is the most
significant and commonly found
infection-causing agent in healthcare
institutions?
A. Bacteria
B. Fungi
C. Viruses
D. Mold
Measures to Reduce Incidence
of Nosocomial Infections
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Constant surveillance by infectioncontrol committees and nurse
epidemiologists
Written infection-prevention practices
for all agency personnel
Hand hygiene recommendations
Infection control precaution techniques
Keeping patient in best possible
physical condition
Multidrug resistant organisms
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Prevent infections, thereby preventing
the spread of resistance
Tracking
Improve antibiotic
prescribing/stewardship
Develop new drugs and diagnostic tests
Clostridium difficile (C diff)
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Seen largely in older adults
Symptomatic and asymptomatic reservoirs
Prolonged antibiotics kill ‘helpful’ bacteria in
intestines then C diff grows!
Watery diarrhea, fever, abnormal cramps
Prevention of C diff
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Avoid use of hard to clean equipment
(electronic thermometer)
Disinfect care items between patients
(stethoscope)
PPE
Meticulous hand hygiene (SOAP AND WATER;
C diff not killed by alcohol based hand rubs)
Keep environment clean
Educate health care providers
Definitions
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Sterilization
Disinfectant
Antiseptic
Factors Determining Use of
Sterilization and Disinfection
Methods
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Nature of organisms present
Number of organisms present
Type of equipment
Intended use of equipment
Available means for sterilization and
disinfection
Time
Unfolding Case Study
This morning you enter Mr. Austin’s room, and he
appears anxious, coughs a lot. He is
complaining of SOB, and pain in his chest, and
his incision site. He states I feel hot, and an
extremely tired.
You recall yesterday that Mr. Austin rang his call
light multiple times with vague complaints, his
VS were WNL
Course of infection
1.
2.
3.
4.
Incubation period—organisms growing and
multiplying
Prodromal stage—person is most infectious,
vague and nonspecific signs of disease
Full stage of illness—presence of specific signs
and symptoms of disease
Convalescent period—recovery from the
infection
Question
In which of the following stages of
infection is the patient most
contagious?
A. Incubation period
B. Prodromal stage
C. Full stage of illness
D. Convalescent period
The Iceberg Effect
Infected
Colonized
Infection
Clinical manifestations
Localized
 Systemic (generalized)
 Acute wound
 Chronic wound
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Cardinal Signs of Infection
Redness
 Heat
 Edema
 Pain
 Loss of function
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Unfolding Case Study
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What would you note in Mr. Austin’s
wound if you were suspicious of a
wound infection; what other signs and
symptoms might he have
What nursing interventions would you
do first?
Infection
Sign & Symptoms
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Depends on agent responsible
for infection and the site of the
infection.
Unfolding Case Study
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What type of signs and symptoms
would Clark Austin have with
pnemonia?
Systemic or local
What type of signs and symptoms
would Clark Austin have with a wound
infection
Systemic or local
Infection
Diagnostic Tests
Vital signs
 CBC, with differential
 Cultures
 Scans
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Communicable
Disease
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Infectious disease that is
highly transmissible to other
people.
Organizations
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WHO
CDC
State Epidemiologist
Local public health department
Inflammation
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Localized response to injury or
infection.
Promotes wound healing
Protective function
Inflammatory
Response
1.
Vascular
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Vasoconstriction
Confine the area of injury, limit tissue damage
Vasodilatation
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Flood area with promote healing
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2.
Results in hyperemia & heat
Cellular
Increased cellular permeability
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WBCs move into area-Clean wound-consume
debris
Results in pain, edema, loss of function
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Exudate - Accumulation of
fluid, dead tissue cells, WBC’s
Types of exudate Serous
 Sanguineous
 Serosanguineous
 Purulent
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Suffix “itis”
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Indicates inflammation
appendicitis
 sinusitis
 gastritis
 bronchitis
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Immune
Response
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Antigen -part of attacking
organism that is responsible for
stimulation of Antibodies
The Antigen, foreign material,
induces a specific immune
response
The Antibody is an immunoglobin
produced by the body in response
to a specific antigen
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Concept in Action-Immune Response
Antigen antibody reaction
Humoral immunity
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Humoral response- Production of
antibodies to a specific antigen by
the B- cell lymphocytes.
Antibodies are released into the
blood stream.
Antibodies bind to the specific
antigen causing their destruction.
Cellular Mediated Defense
Cellular Immune Response
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T - lymphocytes = T Cells
Attack foreign invaders directly
Initiated by the binding of an
antigen with an antigen receptor
located on the surface of the T cell.
Results in total destruction of the
invading microbes or neutralization
of the toxins.
Types of Immunity
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Passive
Natural - From the mother
Artificial - Injection of serum from
immune person
Active
Natural - Have the disease
Artificial - Immunization with antigen
CDC guidelines to prevent
infection
Standard Precautions (Tier One)– Acknowledge that all blood,
body fluids excretions or secretions, mucous membranes,
tissues, contaminated items, & non intact skin are potentially
infectious –ALL Patient contact
Transmission Based Precautions(Tier Two) used in addition to
standard precautions for patients with suspected infection
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Airborne Precautions – Used for patients known or suspected
to have infections transmitted by airborne transmission
(organisms that can be suspended in air for prolonged periods)
 Droplet Precautions – Used for patients known or suspected
to have infections transmitted by the droplet transmission route
(organisms may travel 3 feet but are not suspended for long
time periods)
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Contact Precautions – Used for patients known or suspected
to have infections transmitted by direct contact or contact with
items in the patient’s environment.
Unfolding Case Study
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If Isolation precautions were needed
after C & S of sputum comes back what
type of precaution might be indicated?
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What type of PPE?
If the wound was draining purulent
matter what type of precaution might
be indicated?
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What type of PPE?
Personal Protective Equipment
and Supplies
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Gloves
Gowns
Masks
Protective eye gear
Room assignments and
Isolation-PPE and respiratory protection
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Airborne Precautions-infection spreads
via air (TB, rubeola, varicella)
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Private room
Monitored negative air pressure
6-12 air changes per hour
Monitored filtration if air recirculated
Door closed; patient stays in room
If patient comes out of room (medically
necessary) must have on surgical mask
Room assignments and
Isolation-PPE
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Droplet Precautions-infection spread in
large droplets
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Private room (if available), door may be
open
If Patient must come out of room
(medically necessary) must wear surgical
mask
PPE and keep visitors 3 feet from infected
person
Room assignments and
Isolation-PPE
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Contact Precautions-infection spread by
direct or indirect contact with patient or
patient’s environment
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Used with multi drug resistant organisms
Limit movement out of room
Avoid sharing patient care equipment
Latex allergy-risk factors
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Health care workers
People with allergic tendencies
People with food allergies (banana,
papaya, avocado, potatoes, kiwi,
chestnuts, pineapple
Latex industry workers
People with spina bifida, asthma, or a
history of multiple surgical exposures to
latex
Health care products with
latex-common
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Gloves
BP cuff
Electrode pads
Stethoscopes
IV tubing
Urinary cath
Tourniquets
Syringes
Surgical masks
Baby bottle nipples
Plus more
Latex allergy-planning care
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Prevent exposure to latex
Treat reaction
Question
Tell whether the following statement is
true or false.
Standard precautions should be used
when caring for a noninfectious,
postoperative patient who is vomiting
blood.
A. True
B. False
Wounds
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Intentional or unintentional
Open or closed
Acute or chronic
http://www.impactlab.net/2009/06/22/
pet-owners-at-increased-risk-ofacquiring-fatal-mrsa-infection/
Unfolding Case Study
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Use criteria of wound description to
describe the type of wound Mr. Austin
has
How could you help Mr. Austin avoid
wound complication of dehiscence or
evisceration in a cholecystectomy RUQ
surgical wound?
Phases of the Wound Healing
1.hemostasis, 2.inflammatory phase, 3.proliferation, 4.maturation
Concept in Action-Acute Inflammation
1. Hemostasis
1.
Vasoconstriction
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Platelets accumulate
along blood vessels
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Blood clot seals wound
1. Hemostasis
2. Vasodilation
Release of intracellular
chemicals
Active hyperemia
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Causes redness and heat
Increased vascular
permeability
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Causes swelling and pain
1. Hemostasis
3. Increased Vascular
Permeability
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Begins immediately , most
active during the first 24
hrs.
Fluid, protein, leukocytes
move from the capillaries
into the tissue spaces.
Causes edema & pain
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1. Hemostasis
Exudate - Accumulation of
fluid, dead tissue cells, WBC’s
Types of exudate Serous
 Sanguineous
 Serosanguineous
 Purulent
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1. Hemostasis
 As fibrinogen leaves the blood,
it is activated to fibrin.
 Fibrin strengthens blood clot
formed by platelets.
 Clot functions to trap bacteria,
preventing their spread, serves
as a framework for healing.
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2. Inflammatory Phase
Follows hemostasis, lasts 4-6 days
WBC’s pass through the blood
vessels into the wound
Acute inflammation-pain, redness,
heat, swelling
Patient may have a general body
response
Macrophages enter wound, ingest
debris, secrete growth factor
Fibroblasts fill the wound
3. Proliferative Phase
(Granulation or Reconstruction)
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New tissue is generated &
the continuity of injured
tissues is restored.
For healing to progress foreign bodies are removedinterferes with wound
healing.
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Undamaged epithelial cells
move from the wound edges
under the base of the clot.
Cells bridge the gap within
48 hrs. re-establishing the
skin’s permeability barrier.
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Epithelial tissues serve as a
barrier between the body &
the environment. (new tissue
is Granulation tissue)
 Halts invasion of bacteria,
toxic material
 Blocks fluid & electrolyte loss
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Fibroblasts (connective tissue)
migrate & deposit fibrin
Fibrin secretes collagen produces tensile strength
Capillaries adjacent to the
wound develop buds
Buds stretch across the fibrin
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Capillaries meet and re-establish the
blood supply
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Provides nutrients & blood supply
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Granulation tissue
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New reddish color, highly vascular tissue
that bleeds easily
4. Remodeling or
Maturation
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Tissues undergo slow
progressive change in size &
shape for months.
Heal by replacement
(remodeled) or regeneration
Healing by Regeneration
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Replacement of destroyed tissue
cells by cells that are identical or
similar in structure and function.
Labile Cells
Stable Cells
Permanent Cells
Healing by replacement
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Collagen continues to be
deposited.
Shrinkage and contraction
Contains fewer pigmented cells
& has a lighter color than
normal skin.
Unfolding Case Study
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What type of wound Clark Austin have
with the cholecystectomy and what
type of tissue repair will it heal by?
If Mr. Austin develops a sacral pressure
ulcer, stage 3; what type of tissue
repair will it heal by?
If Mr. Austin was admitted with
ruptured appendicitis and abdominal
abcess; what type of tissue repair will it
heal by?
Tissue Repair
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Primary intention- clean, surgical
incision
Secondary intention- edges do not
close, heals from the inside out
Tertiary intention- delay in surgical
suturing, but is eventually sutured
http://what-when-how.com/nursing/special-skin-and-woundcare-client-care-nursing-part-3/
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Clean Hand Jive
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https://www.youtube.com/watch?v=sS-KyhAzeUY&feature=related