Lesson Objectives

Describe infectious agents & list examples Distinguish between pathogens & nonpathogens Describes the six links in the chain of infections

List the the bodys defense mechanisms against pathogens

Describe the events of the inflammatory process Differentiate between local & generalized infections

Describe reasons for increased risk of infections

List nursing interventions to prevent or control infection transmission List Diagnostic testing used for patients suspected of having am infection Describe Nursing Care for a client with a potential or actual infection

Vocabulary
Epidemic- A few cases of a very rare disease may be classified as an epidemic, while many cases of a common disease (such as the common cold) would not. Epidemic- an infection is said to be "endemic" in a plant/animal population when that infection is maintained in the population without the need for external inputs. A pandemic (from Greek pan "all" + demos "people") is an epidemic of infectious disease that is spreading through human populations across a large region; for instance multiple continents, or even worldwide. A widespread endemic disease that is stable in terms of how many people are getting sick from it is not a pandemic

Infectious/ Disease causing agents

Bacteria Viruses

Protozoans
Mycoplasmas

Fungi
Rickettsiae

Helminths
Prions

Bacteria
Single-celled Classified by shape & how they grow Cocci- round; Bacilli- rodshaped; Spirochete- spiralshaped.

Anaerobic and Aerobic

Bacteria- the good

Bacteria living in the gut can help animals break down food. These so-called good bacteria help maintain the conditions necessary for food digestion.

Bacteria have long been used by humans to create food products such as cheese, yoghurt, pickles, soy sauce and vinegar.
Bacteria is used to break down our sewage and to clean up oil spills. We manipulate bacteria to grow a protein of interest, for example, insulin, and then grow them in large vats to produce a large quantity of the desired protein.

Bacteria- the bad

MULTIDRUG RESISTANCE:
Inappropriate prescriptions Poor compliance of patients Prophylactic antibiotic precriptions Exposure of antibiotic to environment Use in animals

MRSA, VRE, TB, & Gonorrhea

Viruses
Hijacks a living cell to grow & reproduce Need a high powered electron microscope to see.

Different viruses infect different types of cells, which is why each causes its own unique disease.

Fungus
Single- celled (yeasts) and multi-cellular The good:
Part of our diet as mushrooms. Also used baking and brewing. Penicillin! The bad:
Superficial infections Intermediate infections Deep infections

Rickettsiae
Like viruses they hijack the hosts cells. Transmitted by Arthropods IE Fleas, ticks, lice, mites & mosquitoes. Rickettsial diseases: Lyme disease, malaria, West Nile, eastern equine encephlitis, Rocky mountain spotted fever, & bubonic plague

Mycoplasmas
Single celled with out cell wall (pleomorphic) Mycoplasmal organisms are usually associated with mucosal surfaces ie Respiratory, GI & GU tracts. They rarely penetrate the submucosa, except in the case of immunosuppression in which case can spread to different organs or the whole body. Can cause pneumonia, urethritis.

Helminths
Internal parasites- Infectious Worms
Nemaodes aka roundworms Cestodes aka tapeworms Trematodes aka flukes or flatworms

Prions
Composed of protein Normal proteins seem to protect against demetia but with mutation can cause TSE ( transmissible spongiform encephalpathies.
Mad cow disease ( bovine spongiform encephaolpathy) Creutzfeld Jakob disease

Vocabulary terms
Infection- Invasion of the body with pathogens or microorganism capable of producing disease. Asepsis- Freedom from disease- causing microorganisms. To decrease the possibility of microorganisms from spreading from one place to another, there are two basic types of asepsis: medical & surgical asepsis.

Medical asepsis or clean technique includes procedures to limit the number of microorganisms & prevent their spread.
Surgical asepsis or sterile technique includes procedures to eliminate microorganisms from the area. Nosocomial infection: Hospital-acquired infections. Develop during or shortly after stays in health care facilities.

Chain of infection

Reservoir
Humans or animals Inanimate objects

Portal of exit/ Mode of escape

Respiratory Gastrointestinal

Genitourinary
Skin & mucous membrane Blood & other body fluids

Means of transmission/ Mode of transfer

Contact

Droplet
Airborne Vehicle Vector

Resource:

http://www.med.yale.edu/ynhh/infection/dislist/intro.htm l

Portal/ mode of entry

Mucous membranes Skin

Respiratory tract
Gastrointestinal tract

Pattern of Transmission
Horizontal Transmission: Direct person-to-person spread. Vertical Transmission: Relies on PERSISTENCE of the agent to transfer infection from parents to offspring. Several forms of vertical transmission can be distinguished: 1.Neonatal infection at birth, e.g. gonorrhorea, AIDS. 2.Infection in utero e.g. syphilis, CMV, Rubella (CRS), AIDS. 3. Germ line infection - via ovum or sperm.

Susceptible host
1. Inadequate nutrition
Poor hygiene Immunosuppression & chronic illness

Prematurity & aging

Non intact skin

Decreased cough reflex

Under immunization Overcrowding/homelessness.

Human Defenses Against Infection

Mechanical barriers
Skin, mucous membranes Normal flora Physiologic reflexes Macrophages Chemical Barriers: Body secretions: saliva, sweat, tears Enzymes: gastric juices, bile, mucus Antibodies

Bodys defenses against infection

Disease-causing agents, also called pathogens, can produce infections within the body.
The body has two lines of defense against pathogens: nonspecific defenses (innate or inborn) that guard against any pathogen, and specific defenses (acquired immunity) that mount a response against a very specific target.

1. Specific defenses are carried out by lymphocytes that recognize a specific invader.
2. Nonspecific and specific defenses work together to protect the body against infection.

Body Defenses Against Infection: Nonspecific Defenses

A. Present at Birth 1. Immediate protection wide variety of pathogens 2. Come in three forms. --External mechanisms (skin, mucous) -- Chemical (sebum, gastric juices, perspiration) --Internal nonspecific: Antimicrobial proteins, NK cells, phagocytes, Inflammation and fever

Body Defenses Against Infection: Nonspecific Defenses

. External Mechanisms (Mechanical and Chemical) Skin keratinized (i) is a barrier sheds easily (ii) is dry (iii) has a low pH (iv) has high salt concentrations (v) possesses lysozyme (in sweat). Mucous membranes Tears (i) wash away pathogens (ii) contains lysozyme

Body Defense Against Infection: Nonspecific Defenses

External Mechanisms (Mechanical and Chemical contd) Urine (i) washes away pathogens (ii) has a low pH (iii) has high salt concentrations Vaginal lining: (i) mucous membrane s(ii) has a low pH Saliva (i) digestive enzymes Stomach (i) has a low pH( (ii) digestive enzymes (iii) mucous membranes

Body Defense Against Infection: Nonspecific Defenses

Internal, Non-specific NK cells, Macrophages and phagocytes Recognize certain antigens, other surface markers, recognize cancer Recognize, adhere, release perforin

Body Defense Against Infection: Nonspecific Defenses

Internal, Non-specific: Inflammation 1. Inflammation- a tissue response to a pathogen, is characterized by
a. redness b. swelling c. heat d. pain.

2. Major actions that occur during an inflammatory response include:

a. dilation of blood vessels b. increase of blood volume in affected area c. invasion of white blood cells into the affected area d. appearance of fibroblasts and their production of a sac around the area.

Body Defense Against Infection: Nonspecific Defenses

Internal, Non-specific: Fever Fever- Abnormally high body temperature that occurs because the hypothalamic thermostat is reset. Occurs during infection & inflammation Bacterial toxins trigger release of fever-causing agents Benefits: intensifies effects of interferons, inhibits bacterial growth, speeds up tissue repair

Body Defense Against Infection: Specific Defenses

ACQUIRED IMMUNITY Immunity -is bodys ability to defend itself against specific foreign material or organismsbacteria, toxins, viruses, cat dander, etc. Differs from nonspecific defense mechanismsspecificity ie:
recognize own cells & non-self cells-memory 2nd encounter produces even more vigorous response

 B. Antigens

Body Defense Against Infection: Specific Defenses

1. Antigens are glycoproteins that function as I.D. tags on the surface of cells. These antigens help the body to recognize which cells belong to the body and which do not. 2 Foreign antigens are attacked by two types of lymphocytes: (T & B Lymphocytes) C. Lymphocyte Functions
T cells attack foreign, antigen-bearing cells, such as bacteria, by direct cell-to-cell contact, providing "cellmediated immunity. B cells are the main warriors of immunity in body fluid
They secretes antibodies Antibodies mark antigens for elimination Like T cells, some of the B cells become memory cells to

Pathophysiology of Infection
Initial reaction is activation of the inflammatory response Signs and symptoms: Localized Redness Heat Swelling Pain Drainage Generalized or systemic effects of inflammation: Fever/ Chills Fatigue/ Malaise Lymph node enlargement Nausea/ Vomiting/ Diarrhea Leukocytosis ( an increase in the number of circulating white blood cells or leucocytes)

Sepsis
Two or more of the following Temperature >100.4 deg F or <96.8 deg F Heart rate > 90 bpm Respiratory rate >20 bpm or PsCo2 < 32 WBC count > 12,000 or >10% immature bands

Purpose- Decrease spread of microorganisms from recognized & unrecognized sources. 1. Washing hands after contact with all of the above regardless of if gloves are worn. Wash hands ( non antimicrobial soap for routine washing) after removing gloves. 2. Wear clean gloves after touching blood, body fluids, contaminated objects etc. And avoid touching non-contaminated items and surfaced after gloves have been in contact with blood & blody fluid etc. 3. Wear a mask, eye protection or face shield, and/ or a gown if splashing of blood body fluids secretions and/ or excretions are expected. 4. Handle patient equipment in a manner to avoid spread of microorganisms ie. Single use equipment or properly cleaned/ reprocessed reusable equipment 5. Handle, transport, and process linen that is soiled with blood, body fluids, secretions, or excretions in a manner to prevent contamination of clothing and the transfer of microorganisms to other/ the environment.

Standard Precautions

Airborne Precautions
Use standard precautions plus: Pt. must be in a negative air pressure room and either discharge of air to the outside or a filtration system for the room air. If a private room is not available, place client with another client who is infected with the same microorganism. Wear a respiratory device (N95 respirator) when entering the room of client who is known or suspected of having primary tuberculosis. Susceptible people should not enter the room of a client who has rubeola (measles) or varicella (chickenpox). If they must enter, they should wear a respirator. Limit movement of client outside the room to essential

Droplet Precautions
Use standard precautions plus: Place client in private room. If a private room is not available, place client with another client who is infected with the same microorganism. Wear a mask if working within 3 feet of the client.

Limit movement of client outside the room to essential purposes. If movement unavoidable, place a surgical mask on the client during transport.

Contact Precautions
Use standard precautions plus: Place client in private room. If a private room is not available, place client with another client who is infected with the same microorganism. Wear gloves as described in Standard Precautions. Change gloves after contact with infectious material. Remove gloves before leaving clients room. Wash hands immediately after removing gloves. Use an antimicrobial agent. After hand washing, do not touch possibly contaminated surfaces or items in the room. Wear a gown (see Standard Precautions) when entering a room if there is a possibility of contact with infected surfaces or items, or if the client is incontinent, has diarrhea, a colostomy, or wound drainage not contained by a dressing. Remove gown in the clients room. Make sure uniform does not contact possible contaminated surfaces. Limit movement of client outside the room. Dedicate the use of noncritical client care equipment to a single client or to clients with the same infecting microorganisms.