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Infection Control
Basic Medical Asepsis Gerontologic
Conciderations
Standard Precautions Management Guidlines
Isolation Critical Thinking
Dr. Aidah Alkaissi Division of
Anaesthesiology & Intensive Care
Linköping University Sweden
Learning Objectives
Describe & draw the six steps in the chain of infection
Explain what is meant by the body´s natural defenses
List and describe conditions that predispose client to infection
Describe what is meant by the term nosocomial infection and disscuss
one intervention that will help to prevent it
List the major organisms responsible for nosocomial infections state
the main purpose of handwashing
Define the terms surgical asepsis and medical asepsis
Describe the modes of transmission of HIV
List precaution principles and explain their main purpose
between the first and second tier of
Describe the difference Dr. Aidah Alkaissi Division of
precautions Anaesthesiology & Intensive Care
Linköping University Sweden
Chain of Infection
For an infection to occur a chain of events must take
place
If the chain is broken through the implementation of
infection control measures, the infection is less likely
to occur
Dr. Aidah Alkaissi Division of
Anaesthesiology & Intensive Care
Linköping University Sweden
The chain of infection involves six
steps
Infection Agent (Microorganism): whether the
microroganism is capable of producing an infection
depends on a number of circumstances
The virulence and number of organisms present
The susceptibility of the host
The existence of a portal of entry and the affinity of
the host to harbor the microorganism
Dr. Aidah Alkaissi Division of
Anaesthesiology & Intensive Care
Linköping University Sweden
The chain of infection involves six
steps- Reservoir- Portal of Exit
Reservoir must provide a favorable environment for growth
and multiplication of the microorganism
These reservoirs include the respiratory, gastrointestinal,
reproductive and urinary tract & blood
Portal of Exit which allows the microorganism to move from
the reservoir to the host . The portal of exit is directly
associated with the reservoir. For example: if the resrvoir is
the respiratory tract, the portal of exit is through sneezing,
coughing , breathing or talking. If the reservoir is blood, the
portal of exit is through an open wound, needle puncture, or
nonintact skin surface.
Dr. Aidah Alkaissi Division of
Anaesthesiology & Intensive Care
Linköping University Sweden
The chain of infection involves six
steps- Mode of Transmission
Mode of Transmission There are five routes of transmission.
The three primary routes are contact, droplet, and air borne.
Too lesser routes are common vehicle(transmission by
contaminated items such as food, water, devices, or
equipment) and vector borne ( (transmitted by vectors such as
mosquitoes fleas, rats)
– Contact transmission: the most frequent source of nosocomial
infection, transmitted via two modes – direct and indirect contact
Dr. Aidah Alkaissi Division of
Anaesthesiology & Intensive Care
Linköping University Sweden
The chain of infection involves six
steps Mode of transmission
Direct contact involves a direct transmission, body to body, and
the physical transfer of microorganisms from one infected
person to another e.g. Through sexual contact, kissing, touch
It may occur when a health care worker touches a client, gives
a client a bath, or performs other care activities
Indirect transmission involves contact with a contaminated
intermediate object such as a needle, instrument, or dressing
This occurs when contaminated hands are not washed and
gloves are not changed between clients
Dr. Aidah Alkaissi Division of
Anaesthesiology & Intensive Care
Linköping University Sweden
The chain of infection involves six
steps
Droplet transmission: it occurs when droplets from
the infected source person are projected a short
distance to the host´s nasal mucosa , mouth or
conjunctiva
These droplets are not suspended in the air, so it is
not considered airborne transmission
Dr. Aidah Alkaissi Division of
Anaesthesiology & Intensive Care
Linköping University Sweden
The chain of infection involves six
steps- Mode of transmission
Air borne transmision occurs by dissemination either
small particle nuclei of evaporated droplets or dust
particles containing the infectious agent
– These agent can be dispersed widely by air currents as
with Legionnaire´s disease & may be inhaled by a
susceptible host.
– These microorganisms include mycobacterium
tuberculosis, rubeola and varicella viruses
Dr. Aidah Alkaissi Division of
Anaesthesiology & Intensive Care
Linköping University Sweden
The chain of infection involves six
steps- Portal of Entry
The most effective barrier to transmission of microorganisms
is an intact skin
For an infection to occur it must have a means of entering the
body
A disruption in the integrity of the skin provides such a port of
entry for microorganisms
Microorganisms also enter the body the same way they leave
the body. The respiratory system provides a vailable portal of
both exit and entry
Dr. Aidah Alkaissi Division of
Anaesthesiology & Intensive Care
Linköping University Sweden
The chain of infection involves six
steps- Susceptible Host
For an infection to occur a susceptible host is needed-
someone who is ”at risk” this includes the clients who are
immunesuppressed, fatigue, stressed, anemic, not
immunized, poorly nourished,
Those who have underlying diseases
Hospitalized client with wounds, catheters, IVs are at high
risk for developing infections.
Clients who require invasive procedures, blood specimen
collections, & surgery are in the high risk category
Dr. Aidah Alkaissi Division of
Anaesthesiology & Intensive Care
Linköping University Sweden
Barriers to infection
An individual´s ability to resist infection is determined
by the status of the body´s defense mechanisms and
by the persons general health
Dr. Aidah Alkaissi Division of
Anaesthesiology & Intensive Care
Linköping University Sweden
Factors that contribute to
susceptibility to infection include
Altered nutritional status
Fatigue disease
Drugs
Metabolic functions
Age
– Clients with severe underlying diseases are more likely to develop
nosocomial infections
– The body is protected against infection by immunities, by the
inflammatory process, and by anatomic barriers that include the skin
and mucous membranes
Dr. Aidah Alkaissi Division of
Anaesthesiology & Intensive Care
Linköping University Sweden
Barriers to infection
When the integrity of the skin or mucous membrane is broken,
both resident and transient flora or bacteria have a direct
route to the internal tissue of the body
To prvent the spread of infection the body´s internal defense
mechanisms mobilize and begin clearing and repairing the
damage site
How quickly a wound heals depends on the degree of
vascularization in the injured area, the location and
cleanliness of the wound and the degree of tissue damage
Dr. Aidah Alkaissi Division of
Anaesthesiology & Intensive Care
Linköping University Sweden
Barriers to infection
The second way the body resists infections is
through immunity , antitoxins, and vaccines
Natural immunity is inherited. Accquired immunity
occurs after an individual has been exposed to a
disease or infection or has been vaccinated
Dr. Aidah Alkaissi Division of
Anaesthesiology & Intensive Care
Linköping University Sweden
Barriers to infection
The third way the body resist infection is through the
inflammatory process
Inflammation involves use of metabolic energy
, increased blood flow to the inflamed areas, in many
cases drainage of inflammatory debris to the external
environment
Dr. Aidah Alkaissi Division of
Anaesthesiology & Intensive Care
Linköping University Sweden
Barriers to infection
When an area becomes inflamed , cells at the site activate the
plasmin system, the clotting system, the kinin system
The result of the activation of these system is the release of
histamine, which creates increase vascular permeability
around the injured site and the release of chemotoxic agents,
which summon phagocytes into the vascular and tissue
spaces
Phagocytes are W.B.C that combat and prevent infection by
ingesting harmful microorganism
Dr. Aidah Alkaissi Division of
Anaesthesiology & Intensive Care
Linköping University Sweden
The body´s natural defences
Almost any organism can be the cause of a
significant nosocomial infection
Some of variables that help determine which
organism emerges as the pathogen are the virulence
and number of organism
The exposure and attachment of the organisms to a
susceptible sitre and the duration of the client´s
exposure to infectious challenge
Dr. Aidah Alkaissi Division of
Anaesthesiology & Intensive Care
Linköping University Sweden
The body´s natural defences
The following formula illustrates these variables
Dose x virulence / host resistance = infection
Using this formula , the client´s risk factors can be evaluated. the
inherent health and immunologic status of the client are major
factors in determining whether an infection occur
Alterations in the skin barrier include any physiologic break in
the integrity of the skin
Intentional breaks are caused by the use of percutaneous
catheter and needles and by surgical procedures.
Unintentional causes of skin breakdown include the
development of presure ulcers and traumatic wounds
Dr. Aidah Alkaissi Division of
Anaesthesiology & Intensive Care
Linköping University Sweden
Conditions predisposing to
infection
Certain conditions and invasive techniques predispose clients
to infection because the integrity of the skin is broken or the
illness itself establishes a climate favorable for the infection
process to occur. Among the most common are surgical
wounds, changes in the antibacterial immune system or
alteration in the respiratory tract or genitourinary tract
Implant such as heart valves, prosthetic grafts, or vascular
grafts can lead to nosocomial septicemias
The extensive use of IV therapy in clients has increased
infections dramatically
Dr. Aidah Alkaissi Division of
Anaesthesiology & Intensive Care
Linköping University Sweden
Surgical wounds
It has been documented that the longer a person is
hospitalized prior to the surgical procedure the
greater the risk of postsurgical infection
Other factors that influence infection rates are
duration of time in the operating room, time surgery
is done (between midnight and 8:00 A.M is period of
greatest risk), whether the client has postsurgical
drains in place, or if the surgery enters a colonized or
infected part of the body
Dr. Aidah Alkaissi Division of
Anaesthesiology & Intensive Care
Linköping University Sweden
Surgical wounds
It is useful for the nurse to be aware of conditions
that increase the risk of postoperative infection
Risk reduction measures include preoperative
showering with an antiseptic solution, the use of
depilatory creams or the clipping of hair in lieu of
shaving the surgical site and keeping the incision site
covered with a dry sterile dressing
Dr. Aidah Alkaissi Division of
Anaesthesiology & Intensive Care
Linköping University Sweden
Surgical wounds
a wet dressing, through osmosis and diffusion ,
pulls organisms down into the wound from the
surface. This is particularly important during the first
45 hours before the wound becomes ”watertight”.
Research shows that preoperative shaving results in
disruption of normal flora on the surface of the skin
Dr. Aidah Alkaissi Division of
Anaesthesiology & Intensive Care
Linköping University Sweden
Antibacterial immune mechanism
Three categories of abnormalities in antibacterial immune
mehanism:
– those affecting inflammatory responses,
– those affecting phagocytic functions and
– those affecting opsonins (humoral immunity)
Anything that interfers with the migration of phagocytic cells to
the area of contamination or with the physical contact of
phagocytes and bacteria enhances the development of an
infection e.g. Deficient blood supplies, the presence of
ischemia or dead tissue, sutured material, foreign bodies,
hematomas.
Dr. Aidah Alkaissi Division of
Anaesthesiology & Intensive Care
Linköping University Sweden
Antibacterial immune mechanism
Vasopressor agents, radiation injury, uremia, severe
nutritional deficiencies, and steroid therapy inhibit the
synthesis of antibodies and other essential proteins
Clients with severe thermal injuries and severe
nutritional deficiencies have abnormalities involving
the number of neutrophils collected at the site of an
inflammatory response and defects of bacterial
chemotoxic capacity
Dr. Aidah Alkaissi Division of
Anaesthesiology & Intensive Care
Linköping University Sweden
Antibacterial immune mechanism
Client with Hodgkins disease have a specific defect
in cell-mediated immunity
Genetic inabilities to synthesize complement
components or specific antibodies can cause
abnormalities in opsonins. Burn client may have
complement inactivated by a circulating substance
released by the damaged tissue without
complement, lysis of cells and destruction of bacteria
cannot take place
Dr. Aidah Alkaissi Division of
Anaesthesiology & Intensive Care
Linköping University Sweden
Respiratory Tract
Alteration that facilitat infection include endotracheal
intubation, tracheostomy, bronchotracheal
suctioning, & stasis due to poor respiratory excursion
for client on bed rest
Catheter placed directly in the trachea can force
pathogenic microorganisms into the respiratory
system
Catheter may damage the mucous lining of the
respiratory tract
Dr. Aidah Alkaissi Division of
Anaesthesiology & Intensive Care
Linköping University Sweden
Genitourinary tract
Instrumentation including catheterization of the
bladder and complicated obstetric delivery after
prolonges confinement in bed are two procedures
that introduce potentially pathogenic bacteria into the
genitourinary tract
Acute urinary tract infection and pyelonephritis occur
after the use of a catheter or cystoscope
Dr. Aidah Alkaissi Division of
Anaesthesiology & Intensive Care
Linköping University Sweden
Invasive devices
Nosocomial septicemias occur as a result of significant
alterations in normal host defences
– Primary infection caused by direct introduction of microorganisms
into the bloodstream
– Secondary arising from an infection at another site such as the
urinary tract
– The most common site for a nosocomial infection is the urinary tract
– The use of IV therapy greatly increases the risk of introducing
harmful microorganisms
Dr. Aidah Alkaissi Division of
Anaesthesiology & Intensive Care
Linköping University Sweden
Invasive devices
– Septicemia may be caused by introduction of
microorganisms from contaminated fluids, infected
venipuncture sites, foci of septic thrombophlebitis as
complication of using an indwelling IV catheter
– Infusion related sepsis is associated with contaminated
infusion fluid which may be contaminated either during
manufacturing (intrensic contamination) or during hospital
use (extrensic contamination)
Dr. Aidah Alkaissi Division of
Anaesthesiology & Intensive Care
Linköping University Sweden
Venipuncture Sites
The wounds made by a percutaneous stick at the venipuncture site may
become colonized or infected
This opening provides a reservoir for bacteria that could move along the
catheter into the bloodstream
Site infections can be reduced by several methods:
– Selecting a catheter appropriate to the size of the vein
– Avoiding sites near joints
– The performance of proper site preparation
– Maintaining regimen for site care
– Changing the site every 48-72 hours as well as maintaining a closed
system of therapy
Dr. Aidah Alkaissi Division of
Anaesthesiology & Intensive Care
Linköping University Sweden
Total Parenteral Nutrition Therapy
Means acheiving an anabolic state in clients who would
otherwise be unable to maintain normal nitrogen balance
The hypertonic solution used with these client supports the
growth of a wide variety of organisms especially fungus
Peripheral inserted central catheter lines may not be changed
for months
Meticulous site care must be done at least every three days to
preserve the site and aseptic technique used when changing
solution, tubing, dressings and filters
Dr. Aidah Alkaissi Division of
Anaesthesiology & Intensive Care
Linköping University Sweden
Implanted prosthetic devices
Include artificial cardiac valves, synthetic vascular
grafts, orthopedic prosthetic joints, neurosurgical
shunts, cerebro spinal fluid pressure monitoring
devices
If the infection is not controlled, removal and
replacement of the prosthesis is indicated
Dr. Aidah Alkaissi Division of
Anaesthesiology & Intensive Care
Linköping University Sweden
Nosocomial infections
Are infections that are acquired while the client is in
the hospital
Infections that were not present or incubating at the
time of admission
Handwashing is the single most importan
intervention to prevent these infections
Dr. Aidah Alkaissi Division of
Anaesthesiology & Intensive Care
Linköping University Sweden
Nosocomial infections
Three major organisms responsible for the majority
of nosocomial infections
– Clostridium difficile
– Methicillin-resistant staphylococcus aureus (MRSA)
– Vancomycin-resistant enterococcus (VRE)
Dr. Aidah Alkaissi Division of
Anaesthesiology & Intensive Care
Linköping University Sweden
Nosocomial infections
The most common organisms
– C.difficile is an anaerobic
– Gram-positive
– Spore-formig bacillus associated with infectious
diarrhea(CDAD)
– 20-40% of hospitalized clients become colonized within a
few days of entering the hospital, because it is often
resistant to antimicrobial therapy, it is able to proliferate in
the hospital setting
Dr. Aidah Alkaissi Division of
Anaesthesiology & Intensive Care
Linköping University Sweden
Nosocomial pneumonia
Affecting 40% of all critically ill or immunosuppressed clients
cause is gram-positive staphylococcus that is methicillin
resistant
Occurs in clients who have invasive procedures such as
intravenous or respiratory therapy treatment or surgical
procedures
Health care personnel easily transmit MRSA to clients
because it frequently colonizes skin
Vancomycin, the drug choice to treat MRSA, is losing its
effectiveness as a treatment
Dr. Aidah Alkaissi Division of
Anaesthesiology & Intensive Care
Linköping University Sweden
Vancomycin-resistant
enterococcus (VRE)
A gram positive bacterium
Normally found in flora of the gastrintestinal tract
When this bacterium mutated and became resistant
to common antimicrobial therapies, it became a
major cause of nosocomial infections in the hospital
setting
Zyvox is the drug choics for VRE and MRSA
Dr. Aidah Alkaissi Division of
Anaesthesiology & Intensive Care
Linköping University Sweden
Standard precaution
1985, universal precautions were instituted as a result of the
human immunodeficiency virus (HIV)
– Blood and body fluid precautions were practiced on all clients
regardless of their potential infectious state
1987, body substance isolation (BSI)was proposed
The intent to isolate all moist and potentially infectious body
– substances (blood, feces, urine, sputum, saliva, wound drainage,
&other body fluids) from all the clients, regardless of their infections
status, primarily through the use of gloves
Dr. Aidah Alkaissi Division of
Anaesthesiology & Intensive Care
Linköping University Sweden
Standard precaution
1994, the CDC drafted new guidlines , contain two
tiers of precautions
The first tier, standard precautions, blends the major
features of universal precautions (blood and body
fluids precautions)and body substance isolation into
a single set of precautions to be used for the care of
all clients in hospitals regardless of their diagnosis or
presumed infection status
Dr. Aidah Alkaissi Division of
Anaesthesiology & Intensive Care
Linköping University Sweden
Standard precaution
The new standard precautions apply to blood all
body fluids, secretions, and excretions, whether or
not they contain visible blood, non intact skin, and
mucous membranes
These precautions are designed to reduce the risk
of transmission of both recognized and
unrecognized sources of infection in hospitals
Dr. Aidah Alkaissi Division of
Anaesthesiology & Intensive Care
Linköping University Sweden
Standard precaution
As a result of the new category of standard
precautions, clients with diseases or conditions that
previously required category-specific or disease
specific precautions are now covered under this
category and do not require additional precautions
Dr. Aidah Alkaissi Division of
Anaesthesiology & Intensive Care
Linköping University Sweden
Standard precaution
The second tier, transmission-based precautions is designed
only for the care of specified clients
This tier reduces the disease-specific precautions into three
sets of precautions based on routes of transmission
These categories are designed for clients documented or
suspected to be infected or colonized with highly
transmissible or epidemiologically important pathogens for
which additional precautions must be used to interrupt
transmission to other in the hospital
Dr. Aidah Alkaissi Division of
Anaesthesiology & Intensive Care
Linköping University Sweden
Types of transmission based
precautions
Airborne precautions reduce the risk of airborne transmission
of infection agents such as measles, varicella, and
tuberculosis
Droplet precautions are used to prevent the transmission of
diseases, such as meningitis, scarlet fever, diphtheria, rubella
and pertussis
Contact precaution are used for clients known or susbected to
have serious illness easily transmitted by direct contact such
as herpes simplex, staphylococcal infections, hepatitis A
respiratory syncyntial virus, wound or skin infection
Dr. Aidah Alkaissi Division of
Anaesthesiology & Intensive Care
Linköping University Sweden
Fundamental principles
1. Handwashing
2. The use of gloves
– Mask, eye protection and face sheild in which splashes or sprays could
come in contact with eyes and mucous membrane
– Gown, should be worn whenever there is a risk of contamination from
blood , bloody fluids, secretions or excretions
– Linen, transport soiledlinens in a manner that prevents skin and mucous
membrane exposure, contamination of clothing and transfer of
microorganisms to other clients and environment- double-bagging linen
before taking it to the laundry facility
3. The proper placement of clients in the hospital to prevent the spread of
microorganisms to others or to the client
4. The appropriate use of isolation equipment to prevent the spread of
care workers and other clients
microorganisms to health Dr. Aidah Alkaissi Division of
Anaesthesiology & Intensive Care
Linköping University Sweden
Occupational health and blood-borne
pathogens
Take precautions to prevent injuries caused by needles,
scalpels or other sharp instruments or devices
Never recap used needles, purposely bend or break needles
by hand, remove needles from disposable syringes or other
handle needles directly
All such instrument should be placed in puncture-resistant
containers for disposal
Mouth pieces, resuscitation bags, or other ventilation devices
should be used as an alternative to mouth –to mouth
resuscitation
Dr. Aidah Alkaissi Division of
Anaesthesiology & Intensive Care
Linköping University Sweden
Client placement
Clients who are at risk for contaminating the
environment or who are unable to maintain
appropriate hygiene or environmental control should
be placed in a private room
Dr. Aidah Alkaissi Division of
Anaesthesiology & Intensive Care
Linköping University Sweden
Guidlines should be considered
when providing client care
Health care workers who have open lesions, upper respiratory
infections, weeping dermatitis should refrain from all direct
client contact and from handling client care equipment
Because of the risk of transmission of HIV and hepatitis B
virus (HBV) frother to fetus, pregnant health workers should
be especially familiar with and strictly adher to precautions to
minimize risk of these viruses.
Currently pregnant health care workers are not known to be at
greater risk of contracting HIV or HBV than other workers
Dr. Aidah Alkaissi Division of
Anaesthesiology & Intensive Care
Linköping University Sweden
Health care workers protection
Statistics from the Centers for Disease Control and
Prevention (CDC)indicating that more than 800,000
needle sticks and sharp injuries were being reported
yearly
Needles stick injuries caused by hollow-borne
needles accounted for 86% of all reported
occupational HIV exposures
Nurses make up 24% of all the cases of HIV
infection among health care workers
Dr. Aidah Alkaissi Division of
Anaesthesiology & Intensive Care
Linköping University Sweden
Health care workers protection
More than 20 pathogens can be transmitted through
small amounts of blood
In addition to HIV and hepatitieB, syphilis, varicella-
zoster, and hepatitis c can be transmitted vis this route
Hepatitis B is the most common infectious disease
transmitted through work-related exposure to blood
About 5,100 health care workers become infected with
Hepatitis B each year
Dr. Aidah Alkaissi Division of
Anaesthesiology & Intensive Care
Linköping University Sweden
Required Immunity Syndrome (AIDS)
Epidemiology and Modes of
transmission
The statistics are chilling: CDC report from US 2001:
79,3000
649,000 are males
134,845 are females
8,994 are children under 13
Estimates are that will be 75 million HIV cases in the top
five industrial nations by 2010
Aids the second leading killer of young men 24-44 y
Aids will be the third most common cause of death in the
united states
Dr. Aidah Alkaissi Division of
Anaesthesiology & Intensive Care
Linköping University Sweden
Required Immunity Syndrome (AIDS)
Epidemiology and Modes of
transmission
Aids is the most serious epidemic facing the modern
world, making knowledge about it and techniques for
caring for the AIDS client mandatory learning for all
nurses. No one is immune to AIDS
The two major risk groups continue to be homosexual
or bisexual men an IV drug abusers which make up
over 2/3 of all AIDS cases
The incidence of female African American cases
increased significantly among infected heterosexuals
(11%)
Dr. Aidah Alkaissi Division of
Anaesthesiology & Intensive Care
Linköping University Sweden
Definitions
AIDS
Defined by CDCas an HIV infection in a person with a CD4+
T-lymphocyte count of less than 200 cells/microliter( L) of
blood or a CD4 percentage of less than 14
26 conditions listed in the category C
– Cytomegalovirus (CMV) retinitis
– Kaposi´s sarcoma
– Mycobacterium avium complex (MAC) which includes the M.avium and
M. Intracellulare organisms
– ´M.Kansasii
– Mycobacterium tuberculosis
– Pnemocytis carinii
– Recurrent pneumoniaDr. Aidah Alkaissi Division of
Anaesthesiology & Intensive Care
Linköping University Sweden
Health Care Workers`Exposure to
HIV
The average risk for HIV-transmission after a percutancous
exposure to HIV-infected blood is approximately 0.3% and
after a mucous membrane exposure is 0.09%
Risk factors for transmission by skin exposure and fluid or
tissue exposure has not been quantified
CDC states 600,000-80,000 needle stick injuries occur each
year with potential risk of HIV exposure
Conciderations that influence the use of postexposure
prophylaxis (PEP) how soon after exposure PEP was begun
and the believe that the infection can be prevented or
the antiretroviral
improved by the use of Aidah Alkaissi Division of drugs
Dr.
Anaesthesiology & Intensive Care
Linköping University Sweden
Exposure definition
Percutaneous injury, contact of mucous membrane, or
nonintact skin, or contact with intact skin when the duration of
contact is prolonged or involves an extensive area, with the
blood, tissue or other body fluids.
Body fluids include semen, vaginal secretions, or other body
fluids contaminated with visible blood (cerebrospinal,
synovial, pleural, amniotic fluids, peritoneal, pericardial)
There is no evidence that tears, sweat, nonbloody urine or
feces transmit HIV
Dr. Aidah Alkaissi Division of
Anaesthesiology & Intensive Care
Linköping University Sweden
A recommendations for PEP
4-week regimen of two drugs (Zidovudine and
lamivudine) for most HIV exposures
An expanded regimen that includes the
addition of a protease inhibitor (indinavir or
nelfinavir) is recommended for HIV exposures
that pose an increased risk of transmission or
when there is a known or suspected resistance
to one or more of the antiretroviral agents
recommended for PEP
Dr. Aidah Alkaissi Division of
Anaesthesiology & Intensive Care
Linköping University Sweden
Tuberculosis
Infectious disease caused by the tubercle bacillus
Mycobacterium tuberculosis
The main reservoir for the organism is the human respiratory
tract
Transmission occurs between individuals through respiratory
contact
The tubercle bacillus enters the respiratory tract on droplets
transmitted through productive coughing from the infectd
individual
Symptoms may occur 4-12 weeks after exposure or may go
unnoticed for many years Alkaissi Division of
Dr. Aidah
Anaesthesiology & Intensive Care
Linköping University Sweden
Tuberculosis
Active pulmonary tuberculosis has a slow, insidious onset
The progression of the active disease and symptoms of
cough, weight loss, fever usually occur within the first two
years after the infection
Latent infections which are asymptomatic are not infectious
and may last a lifetime
Without RX tuberculosis progresses to other body sites
Disseminated tuberculosis occurs in many of the body areas ,
not just the lungs
The incidence of tuberculosis cases has increased greatly,
Dr. AIDS epidemic
due in large part of the Aidah Alkaissi Division of
Anaesthesiology & Intensive Care
Linköping University Sweden
Tuberculosis
Immunosuppressed hosts are very vulnerable to the bacillus
In addition to immunosuppressed individuals , other
concidered at high risk for infection include alcoholics; IV drug
abusers, individuals who share a closed environment with the
infected individual, residents of instituations such as long term
care , foreign-born individuals from countries with a high
prevalence of tuberculosis, such as Asia, Latin America,
Africa, Mexico, the former Soviet Union, low income
populations who are medically underserved
Dr. Aidah Alkaissi Division of
Anaesthesiology & Intensive Care
Linköping University Sweden
Tuberculosis
Early recognition and treatment of tuberculosis must be
intiated prompltly and isolation measures instituted to prevent
the spread of the disease
The purified protein derivative (PPD) skintest is used to
quickly identify the infection in the absence of clinical
stmptoms
Sputum specimens for AFB and culture and sensitivity and
chest x-rays are also orderedto rule out TB
A PPD skin test is read 48-72 hours after the injection
A positive skin test is indicated by an induration of 5-10 mm at
the site of injection Dr. Aidah Alkaissi Division of
Anaesthesiology & Intensive Care
Linköping University Sweden
Tuberculosis
A two step method is now being used, particularly with health
care workers
The procedure involves the first PPD to be given and read
within 48-72 hours
If the PPD is negative or doubtful the PPD is repeated in one
week.
If the client has a positive reaction, he or she is started on a
prophylaxis regimen
A client who is known to be HIV positive with a 5 mm or
larger duration at the site of the PPD injection should be
Dr. tuberculosis
concidered positive for Aidah Alkaissi Division of
Anaesthesiology & Intensive Care
Linköping University Sweden
Viral Hepatitis
There are six forms of hepatitis, each form differs in regard to
incubation period, route of transmission, antigenetic
properties and progression to chronicity
All forms of hepatitis produce an inflammatory response to the
liver which is characterized by liver cell necrosis, inflammation
and cell regeneration
The three major forms of hepatitis are hepatitis A virus (HAV),
Hepatitis B Virus (HBV) and Hepatitis C virus (HCV).
Hepatitis D virus (HDV) is not as common and Hepatitis E
(HEV) is rare
Dr. Aidah a recently
Hepatitis G Virus (HGV) is Alkaissi Division ofisolated blood-borne
Anaesthesiology & needle-sticks and blood
infectious agent transmitted byIntensive Care
Linköping University Sweden
Viral Hepatitis
Hepatitis A (HAV) is spread via the fecal-oral route and sexual
transmission
Poor sanitation and handwashing is a major source of
infection
Approximately 152,000 infections occur in the United States
each year. 99% of those infected recover without any serious
problems
HAVRIX vaccine is available to prevent HAV
Once exposed to the infection or as a preventive therapy,
immune serum globulin is administered intramuscularly
Dr. Aidah Alkaissi Division of
Anaesthesiology & Intensive Care
Linköping University Sweden
Viral Hepatitis
HepatitisB (HBV) is spread through infected blood or body
fluids and through two nonparenteral routes, sexual contact
and perinatal transmission
Contaminated needles, syringes, and blood products are the
most common mode of transmission
About 30% of the cases are spread through sexual contact
140,000 individuals are infected yearly in US
2-10% of adults become chronically infected with HBV
following an infection
HBV is 100 times more infectious than HIV
HBV vaccine provides active immunity in over 95% of
Dr. Aidah Alkaissi Division of
Anaesthesiology & Intensive Care
recipients Linköping University Sweden
Viral Hepatitis
Hepatitis B immune globulin provides passive immunity to
individuals who have contact with HBV-contaminated material
Hepatitis C (HCV) is transmitted primarily by contact with
contaminated blood and blood products
85% of those infected with HCV will remain chronically
infected
Chronic HCV infection is the main causal factor for nearly one
third of all liver transplants
Thre are three types of interferon used to treat HCV
The CDC recommends the use of standard precautions with
clients known to have hepatitis Division of
Dr. Aidah Alkaissi
Anaesthesiology & Intensive Care
Linköping maintained
The precautions should be University Sweden for one week after the
Severe Acute Respiratory
Syndrome (SARS)
In 2003, there was a multi-country outbreak of a virus
suspected to be a mutated form of the corona-virus (the
common cold)
The specific SARS pathogen is not known
There is speculation that this new virus has jumped from
animal to human, setting up the possibility for a world-wide
pandemic like 1918 swine or spanish flu that infected millions
of people around the world and killed more than 20 million
Jumping species from animal to human and being able to
transmit person to person is the worst possible combination of
events because it can cause havoc in a non- immune
Dr. Aidah Alkaissi Division of
population Anaesthesiology & Intensive Care
Linköping University Sweden
Severe Acute Respiratory
Syndrome (SARS)
Because of this potential for disaster, the world Health
Organization issued a global alert when this corona virus
rapidly spread to 26 countries
The primary symptoms of SARS are malaise, aching muscles,
a persistent fever < 38, dry cough, shortness of breath or
breath difficulties, normal WBC
People with these sympyoms who have recently traveled to
or been in the far east, are adviced to see a doctor
immediately
There is only supportive RX including oxygen and ventilatory
assistance when necessary
Dr. Aidah Alkaissi Division of
Anaesthesiology & Intensive Care
Linköping University Sweden
Severe Acute Respiratory
Syndrome (SARS
Total infection control precautions are essential to
prevent transmission
These would include goggles or glasses to protect
mucous membranes of the eyes, N95 mask, gown
and gloves
Washing hands carefully is essential
Dr. Aidah Alkaissi Division of
Anaesthesiology & Intensive Care
Linköping University Sweden
What is Biohazard Waste
Any solid or liquid waste that may present a threat of
infection
This could include laboratory waste, blood or blood
products, body fluids, absorbent material saturated
with blood or body fluids (either wet or dry), discarded
sharps, nonabsorbent disposable devices (drains,
excretions, gloves, urine specimen)
Dr. Aidah Alkaissi Division of
Anaesthesiology & Intensive Care
Linköping University Sweden
Storage of Biohazard Material
Must be apprpriately sealed
May be stored for 30 days
Time starts when material is placed in the sharps container or
biohazard bag
All biohazard waste must be restricted, locked up, or placed in
a separate storage area
Must be labeled correctly so that there is a tracking method
for each bag, container
Labels should say ”medical waste” and ”biohazard” and be
dated when the bag was first placed in the area
Dr. Aidah Alkaissi Division of
Anaesthesiology & Intensive Care
Linköping University Sweden
Human immunodeficiency virus
(HIV)
Is a blood-borne infective retrovirus that invades the CD4+ T-
lymphocyte (immunity cells), dublicates itself by means of that
cell
Infection of HIV progresses to AIDS in at least 35% of those
infected
Once the client has been diagnosed with HIV, the usual
approach to care includes evaluation of the immune system
and classification by CDC grouping (A) asymptomatic, (B) acute
symptomatic, and (C) AIDS- indicator conditions
Dr. Aidah Alkaissi Division of
Anaesthesiology & Intensive Care
Linköping University Sweden
Human immunodeficiency virus
(HIV)
Identification and RX of infectious and neoplastic
complications, initiation of approved antiretroviral
therapy and concideration of experimental measures
are included in the evaluation
Dr. Aidah Alkaissi Division of
Anaesthesiology & Intensive Care
Linköping University Sweden
HIV is transmitted through high-risk
behaviors or other contact with the
virus including
Sexual contact with HIV-infected individuals
Sharing needles with HIV-infected individuals
Transfusions of blood or blood products from infected
individuals (not common today, but new cases are still
reported)
Babies who become infected from the mother before or during
birth, or through breast-feeding
Contact with contaminated needles, blood, secretions, or
excretions from an HIV infected client
Dr. Aidah Alkaissi Division of
Anaesthesiology & Intensive Care
Linköping University Sweden
Health Care Workers´Exposure to
HIV
Dr. Aidah Alkaissi Division of
Anaesthesiology & Intensive Care
Linköping University Sweden
