Infection Control

Barriers to Health Locus of control

Internal Locus: self-directed, researches and maintains present health

External Locus: Others must do what they can to treat or teach the person to be healthy.

Healthy People

Healthy People 2000 & 2010 are goals for health set forth by committee and the Surgeon General of the United States. Recommendations for 2010:

1. increase quality and years of healthy life2. eliminate health disparities

Identification Treatment & Superbugs

A culture and sensitivity must be done prior to treatment.

If the organism is sensitive to an antibiotic, it is administered to eradicate the infection. The med should be chosen that is sensitive and the least expensive.

Another consideration is the strength of the anti-infective. Use lesser agents if effective, not the super-broad spectrum preparations. (Help prevent resistance)

Infection Process

Agent

Environment

HostHost

Infectious Process

AgentEnvironmentHost

The Chain of Infection Transmission

Organisms

PrionsVirusesBacteria

Cocci Bacillus Spirochetes

MycoplasmasRickettsiae, Chlamydiae, Ehrilichieae and

CoxiellaFungiParasites

Agent

Causative Agent- Humans co-exist with many micro-organisms in a mutually beneficial relationship. Many reside on or in the host and usually do not cause harm.

Examples: E.Coli in the bowel Staph Aureus on the skin Fungus in the vaginal canal

Reservoir or Environment

Transmission of an infectious agent from a source to a susceptible host occurs when the host comes into contact with a reservoir where organisms have lived and multiplied. Examples are infected people, plants, soil, food, etc.

Infected people are the reservoirs for most bacteria and viruses that affect humans.

Routes of transmisson

(May be more than one route)ContactDropletAirborneVehicleVector

Host

Some humans are more susceptible to infectious agents.

Factors such as age, sex, ethnicity, heredity, socioeconomic status, general health, lifestyle (IV drug abuser, unsafe sex practices, ETOH abuse, sedentary lifestyle), nutritional integrity, pre-existing illness (diabetes), hygiene, and living conditions.

Precautions

StandardAirborneDropletContactStrict contact

Latent Period of Infection

The time during which the pathogen is replicating with no symptoms in the client, but the client is infectious.

Sub-Clinical Infection

An asymptomatic response of the host to the pathogen.

An asymptomatic host can still transmit a pathogen. The host may harbor the pathogen in sufficient quantities to shed it at any time after latency and toward the end of the incubation period. The time during which an organism can be shed is called the “period of communicability” Example-Varicella.

Nosocomial Infections

Occurs within 48-72 hours of admission to the health care facility.

No incubation on admission.Increases morbidity which increases

hospitalization costSources:

Health Care Workers Clients Liquids, Inanimate objects

HANDWASHING AND GOOD SANITARY HABITS HELP

Common Infection Sites

Urinary Tract Infections E. Coli, Klebsiella pneumoniae

Pneumonia Pseudomonas Aeruginosa

Surgical Wound Infection Endogenous Exogenous

Blood Stream Staph aureas- becoming more prevalent with the use

of central venous catheters.

Clostridium Difficile

Cause- Overuse of antibiotics that disrupt the normal flora of the bowel

Antibiotic resistant spores proliferate in the intestine and release toxins into the lumen of the bowel

Pseudomembranous colitisDiagnosisTreatmentWhat not to doComplicationsRemember

Methacillin-Resistant Staphlococcus Aureus

MRSA has evolved over years of antibiotic use.

Now community acquired forms of MRSA are becoming more and more prevalent. (CA-MRSA).

Vancomycin-resistant staph aureus (VRSA)TreatmentUncertainty of colonization

Vancomycin-Resistant Enterococcus

VRE- normal flora of the GI tract that produces significant disease when it infects blood, wounds or urine.

TreatmentMulti-drug resistant VRE

Immunity

The 1st line of defense –Physical Intact skin Mucous membranes Oil and Perspiration on the skin Cilia active and present in the respiratory passages

(mucus pump. Gag and cough reflexes Peristalsis of the GI tract and gastric secretions Flushing action of tears (lysozyme), saliva, and mucus.

Lines of Defense (continued)

Second line of defense is the inflammatory process.

Third line of defense is the immune system. Cellular immunity-T cells –cell on cell activity Humoral immunity-B-cells (AKA plasma cells)-

antibodies

Preventing & Controlling Infections

HANDWASHING- Hand sanitizer is an effective substitution for handwashing except for Clostridium difficle (very stubborn spore-former)

Standard PrecautionsEducationImmunizations (New-Rototeq, Gardisil)Proper use of personal protective equipment

(PPE)Isolation precautionsHousekeeping PracticesOSHA regulations

Reducing Infectious Diseases

Maximizing host defenses through vaccination.

Active Vaccination Modified infecting agent (vaccine or toxin) to

stimulate the immune response. Passive Vaccination-passive immunity by

administering antibodies.

Regulatory Agencies & Vaccinations

Measles, Mumps, Rubella (MMR)- 2 doses after 12 months of age

Tuberculosis screening- On employment and annually.

VaricellaHepatitis B- 3 doses

Infection Control Programs

Minimize Nosocomial Infections Surveillance Reporting Control Prevention

Barriers prevent the transfer of an infectious organism to the host

There is no barrier that can substitute for handwashing!