Infection Study Guide
 Infection
 Infection is the invasion by a susceptible host by microorganisms resulting in disease. Disease results if
they multiply and cause tissue dysfunction.
 Microorganisms include: bacteria, viruses, fungi and protozoa
 Colonization occurs if the microorganism is present but does not cause disease.
 Chain of Infection
 Infectious Agent: bacteria, virus, etc.
 Reservoir
 Portal of exit
 Method of transmission
 Portal of entry to susceptible host
 Susceptible host: HCP, another patient
 Pathogens and Infectious Agents
 Bacteria
 Fungi
 Viruses
 Parasites
 Reservoir
 A place where microorganisms can survive, multiply and await transfer to a susceptible host
 Ex: health care workers, patients, equipment, insects, food, water
 Humans can be carriers (asymptomatic) or have acute disease
 Portal of exit
 Nose or mouth: sneezing, coughing
 Mouth: saliva, vomit
 Anus: feces
 Vaginal discharge, Semen
 Drainage from cut or wound
 Method of Transmission
 Direct: person to __________________ Indirect
 Vehicle borne (toys, surgical instruments, etc)
 Vector borne (animal or insect)
 Droplet
 Airborne
 Portal of Entry
 Portal of Entry
 Break in skin
 Or same route used to leave source (see portal of exit)
 Susceptible Host
 Susceptible Host= at risk for infection
 No longer susceptible if acquired immunity
 Natural active immunity = already had the disease and developed an immune response; lasts a
lifetime (ex: chicken pox)
 Natural passive immunity = acquired from another person (ex: newborn from mother); is shortterm
 Defenses Against Infection
 Normal flora
 On skin, in saliva, and in intestine
 Help prevent infection
 Broad spectrum antibiotics eliminate/change normal flora and can cause _________________- Inflammation: protective vascular reaction that delivers fluid, blood products and nutrients to area of
injury
 Response: Body creates antibodies to bind to antigens and eliminate the antigen
 ____________________-- Infection
 = Health care associated infections
 Common sites : Wound infections; Bloodstream/Sepsis; Pneumonia; UTIs; Bone/Joint; Cardiovascular;
CNS; GI; Skin
 Reduction of health care associated infections is JCAHO 2006 National Patient Safety Goal
 Hand hygiene and aseptic techniques reduce incidence
 * You are responsible for providing a safe environment for your patients
 Terms R/T Infection
 Asepsis: Freedom from disease-causing organisms
 Sepsis: State of infection, including septic shock
 Surgical asepsis/Sterile technique: practices keeping area free of microorganisms
 Experience of having an infection
 Creates feelings of anxiety, frustration, anger in patients and families
 Worsens if isolated: avoidance, feelings of rejection
 Helps to explain isolation procedures and maintaining friendly manner
 Risk Factors for Infection
 Age
 Newborns: immature immune system, protected for first 2-3 months by passive immunity from
mother
 Elderly: immunity decreases (thus a need for flu and pneumonia vaccine)
 Heredity: genetic susceptibility (may be deficient in immunoglobulins)
 Culture: influences decisions to seek treatment
 Poor nutrition: increases susceptibility and delays wound repair
 Stress: Elevates blood cortisone -> decreases Anti-inflammatory response --> decreased resistance to
infection and exhausts energy stores
 Inadequate rest and exercise: increase stress and decrease functions
 Inadequate defenses: broken skin, traumatized tissue, suppressed immune response
 Personal habits: smoking, alcohol, risky sexual behavior
 Environmental factors: crowded living conditions; safe water; inadequate refrigeration and cooking
 Immunization/Disease history
 No immunizations increase risk
 Chronic medical conditions such as diabetes
 Medical therapies
 Cortisone
 Invasive therapies (IV catheters, surgeries)
 Assessing: local vs systemic
 Localized: redness, swelling, tenderness. Sometimes purulent drainage
 Systemic: Fever, chills, nausea/vomiting, loss of appetite, lymph node enlargement
 Labs
 Indicating infection:
 Increased _____________________
 Positive cultures (wound, urine, blood, sputum)
 Showing risk for infection
 Decreased WBC (may need protective isolation)
 DIAGNOSING/ PLANNING
 Nursing Diagnosis:
 Risk for Infection
 “Infection” is a collaborative problem
 Planning/Goals:
 Maintain or restore defenses
 Avoid spread of infectious organism
 Reduce or alleviate problems associated with infection
 IMPLEMENTING
 Health Promotion
 Prevention and Strengthening Defenses through nutrition, immunization, hygiene, rest, exercise and
hand hygiene
 Acute Care:
 Good hand hygiene!
 Isolation precautions to prevent spread of infection
 Collection of specimens for treatment
 Systemic infections: prevent complications
 Dressings and drainage tubes
 Support defenses
 Principles of Sterile Technique
 #1: A sterile object remains sterile only when touched by another sterile object.
 #2: Place only sterile objects on sterile fields.
 #3: A sterile object out of the range of vision or an object below the waist is contaminated.
 #4: A sterile object becomes contaminated by prolonged exposure to air.
 #5: A sterile object becomes contaminated by capillary action when a sterile surface comes in contact
with a wet surface.
 #6: A sterile object becomes contaminated if gravity causes a contaminated liquid to flow over the
object.
 #7: The edges of a sterile field are contaminated.
 #8: Items of doubtful sterility are considered contaminated
 Pharmacological Interventions
 Antipyretics
 Analgesics
 Anti-infectives: antibiotics, antifungal, antiviral
 Administering antibiotics
 Peak/trough levels and compatibilities
 SE: Anaphylactic vs. rash, itching
 Corticosteroids
 Universal Precautions
 Used with all clients to decrease risk of transmitting unidentified pathogens
 Personal Protective Equipment: gloves, mask, gowns, eyewear
 Interfere with transmission of Bloodborne Pathogens
 HIV, Hep B, Hep C
 Steps to follow if exposed:
 Flush, encourage bleeding
 Report immediately
 Testing of source individual and nurse
 Preventative Prophylaxis if indicated
 CDC Isolation Precautions
 Tier 1: Standard/Universal Precautions:
 Blood, body fluids, non-intact skin, mucous membranes
 Tier 2: Transmission Based Precautions in addition to Universal Precautions:
 Airborne
 Droplet
 Contact
 CDC Airborne Precautions
 Airborne: for droplets < 5 microns (Ex: TB, measles, chicken pox)
 Private room with negative pressure and filtration/discharge of air to outside
 Staff wears respiratory protection device in room of client with suspected Tb
 Susceptible persons should not enter room of client with measles (rubella) or varicella (chicken pox)

Move client outside of room only for essential purposes and place a surgical mask on during
transport
 CDC Droplet Precautions
 Droplet > 5 microns: pneumonia, rubella, mumps, etc:
 Client in private room
 Wear a mask when within 3 feet of client
 Limit patient movement outside of room and client wears surgical mask if transported
 CDC Contact Precautions
 Contact: transmitted by direct contact or contact with items in client environment
 Client in private room
 Gloves, gown, mask, dedicated equipment
 Remove gloves before leaving room and wash hands with antimicrobial agent
 Ex: C-diff, VRE (Vancomycin Resistant enterococci), MRSA (Methillin-resistant Staph. Aureus)
 Psychosocial Needs of Isolation Clients
 Decreased ___________________________
 Associate lack of cleanliness with infection
 Sensory Deprivation (lack of communication)
 Symptoms: boredom, slowness of thought, increased sleep, anxiety, hallucinations
 Interventions: Assess need for stimulation and initiate measures, Explain infection and procedures,
warm/accepting behavior, do not use stricter precautions than necessary
 What YOU can do to prevent Nosocomial Infections
 Strict Aseptic Technique on any invasive procedure (inserting IV or catheter, suctioning airway,
changing dressings)
 Handle needles carefully
 Change IV tubing according to policy
 Prevent UTI: catheter/perineal care, keep drainage bag & spout off floor
 Prevent impaired skin integrity
 Prevent accumulation of secretions in lungs
 Cough and deep breath, IS, ambulation