Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
• Pathogen—microorganism capable of producing disease
• Communicable—infection transmitted from person to
person
• Pathogenicity—ability to cause disease
• Virulence—degree of communicability
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
• Normal flora—characteristic bacteria of a body location;
often competes with other microorganisms to prevent
infections
• Colonization—microorganism present in tissue but not yet
causing symptomatic disease
• Surveillance—tracking and reporting of infections
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
• Reservoir
• Pathogen
• Toxin
• Exotoxin
• Endotoxin
• Host defenses:
• Susceptibility
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• Resistance to infection usually associated with presence of
antibodies or cells acting on specific microorganisms
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• Passive immunity—of short duration, either naturally by
placental transfer or artificially by injection of antibodies
• Active immunity—lasts for years, occurs naturally by
infection or artificially by stimulation (vaccine) of immune
defenses
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•
•
•
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Respiratory tract
GI tract
Genitourinary tract
Skin/mucous membranes
Bloodstream
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Contact—direct or indirect
Droplet—e.g., influenza
Airborne—e.g., tuberculosis
Vector-borne—e.g., insects/animals (Lyme disease)
Contaminated food/water
Portal of exit
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•
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Body tissues
Phagocytosis
Inflammation
Immune systems
• Antibody-mediated
• Cell-mediated
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• HAI acquired in inpatient setting; not present at admission
• Endogenous infection—from patient flora
• Exogenous infection—from outside the patient, often health
care workers’ hands
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• Practice hand hygiene, proper handwashing
• Personal protective equipment (PPE)
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Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
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•
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Adequate staffing
Sterilization
Disinfection
Patient placement
• Cohorting
• Patient transportation
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• Standard Precautions
• Respiratory hygiene/cough etiquette (RH/CE)
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Patient, staff, and visitor education
Posted signs
Hand hygiene
Cover nose/mouth with tissue
Safe infection practices
• Safe injection practices
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• Airborne Precautions
• Droplet Precautions
• Contact Precautions
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• Negative airflow rooms required to prevent spread of
microbes
• HEPA filter
• For TB, measles, chickenpox
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• For droplet transmission route
• Protect from droplets that may travel 3 feet but are not
suspended for long periods
• For influenza, mumps, pertussis, meningitis
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• For known or suspected infections transmitted by direct
contact or contact with items in environment
• For MRSA, pediculosis, scabies, RSV, C. difficile
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Vancomycin
Linezolid
Community-associated MRSA
Health teaching best way to decrease incidence
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• Healthy non-hospitalized people infected
• Health teaching best way to decrease incidence
• Perform frequent hand hygiene, including use of hand
sanitizers
• Avoid close contact with people with infectious wounds
• Avoid large crowds
• Avoid contaminated surfaces
• Use good overall hygiene
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Vancomycin-resistant Enterococcus (VRE)
Multidrug-resistant tuberculosis
Gonorrhea
Vancomycin-intermediate Staphylococcus aureus (VISA)
Vancomycin-resistant S. aureus (VRSA)
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• “Slimy,” very hard to treat
• Antimicrobial catheters (silver alloy or antimicrobial
coating) recommended to decrease encrustation
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• Noncompliance/nonadherence
• Legal sanctions compelling a patient to complete treatment
(e.g., TB)
• Septicemia
• Septic shock
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• Normal bacteria that live in intestinal tract; important for
digestion
• Cause infection outside GI tract
• Can live on almost any surface
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• History
• Physical assessment and clinical manifestations
• Psychosocial assessment
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• Laboratory assessment:
•
•
•
•
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Culture and antibiotic sensitivity
CBC
ESR
Serologic testing
Imaging
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• Home care management
• Teaching for self-management
• Health care resources
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A 27-year-old patient is admitted from the ED to the medsurg unit with cellulitis of the left leg. A culture result from
her primary care provider’s office indicated she was positive
for MRSA in the leg wound.
Based on this information provided during the SBAR report,
what type of isolation room should the nurse prepare for the
patient when she arrives on the unit?
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After the patient is settled in her room, what special
precautions does the nurse implement based on her diagnosis?
(Select all that apply.)
A. Wear gloves when entering the room.
B. Wear a mask when working within 3 feet of the patient.
C. Wear a gown to prevent contact with contaminated items.
D. Keep the door closed at all times.
E. Dedicated equipment should be used for this patient
alone.
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An hour later, the nurse is preparing to administer the
patient’s medications. Which drug was likely ordered by the
provider to combat the patient’s MRSA?
A. Amoxicillin (Amoxil)
B. Ciprofloxacin (Cipro)
C. Erythromycin (Erythrocin)
D. Vancomycin (Vancocin)
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After lunch, the patient asks how she could have contracted
the MRSA infection. What is the nurse’s best response?
A. “Some people who travel to third-world countries return
with this infection.”
B. “The most common way for MRSA to spread is through
coughing illnesses such as flu.”
C. “ MRSA is spread by direct contact in hospitals and
communities.”
D. “In the community, MRSA is transmitted by the airborne
route carried by droplets.”
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32
Cleansing hands with an alcohol-based hand rub is
appropriate in which situation?
A.
B.
C.
D.
After administering medications to a patient
After working with a patient who has diarrhea due to
Clostridium difficile
After using the bathroom
To cleanse visibly soiled or sticky hands
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Which person is at greatest risk of infection?
A.
B.
C.
D.
36-year-old prescribed a 10-day steroid tapper
64-year-old with history of prostate hyperplasia
24-year-old with chronic kidney disease
37-year-old pregnant woman
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What health care acquired infection (HAI) occurs most
frequently?
A.
B.
C.
D.
Surgical site infection (SSI)
Catheter-associated urinary tract infection (CA-UTI)
Catheter-related bloodstream infection (CR-BSI)
Pneumonia
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