INFECTIOUS DISEASE CONTROL

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INFECTIOUS DISEASE CONTROL Powered By Docstoc
					INFECTIOUS DISEASE
CONTROL




   DEBORAH “PEPPER”
   HOOVER, RN, MSN
INFECTION CONTROL




 YOUR CLIENT’S LIFE &
  YOUR LIFE DEPENDS ON
  IT !!!!!!!
INFECTION
The invasion of the body by pathogens
Pathogens are microorganisms capable
 of producing disease
If organisms fail to injure cells or tissues,
 it is considered to be asymptomatic
Disease results if pathogens multiply &
 alter normal tissue function
Communicable diseases are infectious
 diseases that can be transmitted directly
 from one person to another
                       DSH
STAGES OF PRIMARY
ACUTE INFECTION

INFECTION - entry of organism into
 body
INCUBATION - time between entry of
 organism & appearance of symptoms
PRODROMAL - appearance of vague
 symptoms such as fever from IL- 1
 release
ACUTE - clinical signs & symptoms
                     -
CONVALESCENCEDSH organism destroyed
TYPES OF INFECTION

PRIMARY ACUTE - relatively short
NOSOCOMIAL - develop after
 admission to health care institution
DRUG RESISTANT NOSOCOMIAL -
 include MRSA, ORSA, & VRE
OPPORTUNISTIC - organisms
 normally controlled by the immune
 system
CHRONIC, LATENT, SECONDARY
                   DSH
DSH
THE CHAIN OF INFECTION

INFECTIOUS AGENT - microorganisms
RESERVOIR - place where
 microorganisms can survive, multiply, &
 await transfer; include humans, animals,
 insects, food, water, organic matter &
 inanimate surface
PORTAL OF EXIT - way to get out
MODE OF TRANSMISSION - contact, air,
 vehicle (water, blood, items, food), vector
                      DSH
CHAIN OF INFECTION
(cont)

PORTAL OF ENTRY - nonintact skin,
 mucous membranes, genitourinary (GU)
 tract , gastrointestinal (GI) tract, or
 respiratory tract
SUSCEPTIBLE HOST - depends on
 person’s degree of resistance to
 pathogens; very young or very old;
 immune compromised by meds or illness
 like chemotherapy or HIV disease
                    DSH
LINES OF DEFENSE
AGAINST INFECTION

EXTERNAL BARRIERS
    SUCH AS SKIN & MUCOUS
 MEMBRANES
INFLAMMATORY RESPONSE
IMMUNE RESPONSE




                DSH
DSH
LEUKOCYTES- WHITE
BLOOD CELLS (WBCs)

NEUTROPHILS- first to arrive at site of
 injury; phagocytosis      *55-70%
EOSINOPHILS- regulate hypersensitivity
 reactions; seen in allergic reactions *1-4%
BASOPHILS- release heparin & histamine
 from granules into tissue*0.5-1%
MONOCYTES (Macrophages)-
 phagocytosis; stimulate maturation of T
 cells *2-8%         DSH
DSH
DSH
WBCs Leukocytes or
Granulocytes

Normal count - percentage of each type
 of WBC
Neutrophils ( polys, segs ) - 55-70%
        *immature segs are bands < 2%
              *go up with infection to 85-
 90%                *called left shift
Lymphocytes - most of remaining 30%
        *go up with leukemia
                    DSH
LYMPHOCYTES

ACTIVE IN IMMUNE RESPONSE
COMPOSED OF:
    B-cells - produce antibodies
         T-cells - mediate immunlogic
 responses
MAKES UP 20-40% OF WBCs



                    DSH
DSH
DSH
DSH
DSH
DSH
DSH
NURSING DIAGNOSES FOR
INFECTION

Altered comfort RT        Altered nutrition <
 tissue injury & fever      body requirements
Activity intolerance      Fluid volume
 RT energy demands          deficit RT fever
Altered health            Risk for infection
 maintenance RT             transmission RT
 lack of knowledge of       colonization with drug
 measures to prevent        resistant organisms
 infection                 Risk of injury RT
                            fever
                         DSH
    IMMUNITY




INNATE versus ACQUIRED
ACQUIRED ACTIVE
IMMUNITY

BODY takes a part in making antibodies
         I. NATURAL ACTIVE - develops
 from disease; best, most long lasting
         II.ARTIFICIAL ACTIVE -
 develops from vaccine; may last years,
 booster may be used



                   DSH
ACQUIRED PASSIVE
IMMUNITY

Antibodies received from another source
          I. NATURAL PASSIVE - passed
 from mother to fetus
          II. ARTIFICIAL PASSIVE -
 injected antibodies from someone else
                    TEMPORARY!!



                   DSH
DSH
INFECTION CONTROL
ABBREVIATIONS

CDC - Centers for Disease Control and
 Prevention; recommended STANDARD
 PRECAUTIONS in 1996; disease
 reduction is goal
OSHA - Occupational Safety and Health
 Administration; mandated use of
 UNIVERSAL PRECAUTIONS in 1991;
 reduction of risk exposure is goal
                    Workers
HCW - Health CareDSH
TO PROTECT YOURSELF &
OTHERS

WASH YOUR HANDS
ALWAYS WEAR GLOVES WHEN
 APPROPRIATE
WEAR PERSONAL PROTECTIVE
 EQUIPMENT IF EXPOSURE IS LIKELY
AVOID RECAPPING USED NEEDLES
CLEAN BLOOD SPILLS & USED PT. CARE
 EQUIP. WITH CAUTION
                 DSH
CDC ISOLATION
GUIDELINES

TIER I - STANDARD PRECAUTIONS
         *Designed to decrease disease
 transmission through ALL body fluids
TIER II - TRANSMISSION - BASED
 PRECAUTIONS
    *Airborne, Droplet, Contact



                   DSH
TRANSMISSION BASED
CATEGORIES
AIRBORNE - spread through air in small
 particles (< 5 microns)
    *measles, chickenpox, pulmonary TB
    *private room, negative airflow,
 respirator
DROPLET - spread through air in large
 particle droplet (>5 microns)
       *diptheria, rubella, mumps,
 pertussis, influenza
           *private room, masks (large
                      DSH
TRANSMISSION BASED
CATEGORIES

CONTACT - spread by direct client or
 environmental contact
     * GI, respiratory, skin, or wound
 infections
     *contagious skin dz such as impetigo,
 scabies
         *Clostridium difficile
    GLOVES, GOWN, PRIVATE ROOM

                     DSH
TO BREAK THE CHAIN OF
INFECTION

              WASH YOUR HANDS!
              Handwashing is the
               single most important
               technique that can
               break the chain of
               infection
              Don’t touch anyone
               until you’ve washed
               & immediately wash
               after contact with
           DSH
               clients
10 COMMANDMENTS OF
INFECTION CONTROL




         DSH
 # 1 THOU SHALT
CONSIDER ALL PERSONS
AS POTENTIALLY
INFECTIOUS




         DSH
# 2 THOU SHALT
VENTILATE YOUR AIR
SPACE AS MUCH AS
POSSIBLE




          DSH
 # 3 THOU SHALT
PROTECT YOUR OWN
IMMUNE SYSTEM BY
NUTRITIOUS DIET,
EXERCISE, PLUS STRESS
REDUCTION

          DSH
# 4 THOU SHALT BE
VACCINATED FOR FLU
YEARLY, HEPATITIS B, &
CHICKENPOX IF NEEDED




           DSH
# 5 THOU SHALT BE
SCREENED FOR
TUBERCULOSIS
EXPOSURE REGULARLY



         DSH
 # 6 THOU SHALT BE
ESPECIALLY CAREFUL
WITH PERSONS WHO
HAVE CANCER, ORGAN
TRANSPLANTS, OR HIV
INFECTION

         DSH
# 7 THOU SHALT NOT
TOUCH ANOTHER
PERSON’S BLOOD OR
OTHER BODY FLUIDS
WITHOUT PROTECTION


         DSH
# 8 THOU SHALT NOT
SHARE INSTRUMENTS
BETWEEN CLIENTS
WITHOUT PROPER
DISINFECTION OR
STERILIZATION

         DSH
 # 9 THOU SHALT NOT
ALLOW YOUR SKIN AS
MUCH AS POSSIBLE TO
BECOME CRACKED,
IRRITATED OR BROKEN IN
ANY WAY

          DSH
 # 10 THOU SHALT NOT
WORRY ABOUT
INFECTIONS AS LONG AS
YOU ARE NOT SPENDING
TIME IN UNVENTILATED
AREAS, TOUCHING BODY
FLUIDS, SHARING USED
INSTRUMENTS OR
NEEDLES, OR HAVING SEX
WITH PERSONS WHO ARE
INFECTED  DSH
NURSING MANAGEMENT
OF ADULTS WITH IMMUNE
DISORDERS




   DEBORAH “PEPPER”
   HOOVER, RN, MSN
  QUIZ

1. What infection was ceritified as eradicated in
 1979?
2. What govt. agency publishes mandatory
 regulations to reduce risk exposure to disease?
3. What is the causative agent of chickenpox?
4. What bacterium has nosocomial potential &
 in extreme form causes pseudomembranous
 colitis?
5. What is the causative agent of AIDS?
                        DSH
Update outline *
CH 64 - p. 1871-2
2 million nosocomial infections/ year
Cost average $18,000 surgical procedure
 with nosocomial inf. vs. $6,000 average
 for other procedures
VISA (vancomycin-intermediate
 Staphylococcus aureus) has happened
100 billion neutrophils released from bone
 marrow daily
 B cells can pump out 1 million antibody
 molecules / hour DSH
MRSA Methicillin-
Resistant
Staphylococcus Aureus *
Endemic in nursing           40% adults & most
 homes, long-term care         children become
 facilities, some              transient carriers
 hospitals                    To eradicate colonization
Transmitted mainly on         use topical mupriocin
 HCW’s hands                  Keep patient in contact
Most frequent site of         isolation
 colonization is anterior      Vancomycin is drug for
 nares                         infection
                            DSH
VRE Vancomycin-
Resistant Enterococcus *

Primarily found in the     Considered colonized
 gut as normal flora         if VRE isolated from
Can invade tissue,          stool or a rectal swab
 proliferate, & cause       Spread through direct
 infection                   contact between
Most vulnerable are         patient & caregiver or
 sickest patients            patient to patient
                            Capable of living for
                             weeks on surfaces

                          DSH
VRE *

Colonization usually       To attack infection
 isn’t treated               MD may order drug
Place patient in            combinations - like
 contact isolation           chloramphenicol,
If infected, MD may         tetracycline, &
 stop all antibiotics &      aminoglycoside
 wait for normal            Wash hands - VRE
 bacteria to repopulate      has been recovered
 & replace VRE               from hands that have
                             been gloved
                          DSH
  Preventing the Spread of
  VRE & MRSA *

Wash hands (VRE on        Don’t use shared
 hands that have been       equipment like BP cuffs &
 gloved; MRSA lives on      electronic thermometers
 hands for 3 hours         If using other equipment
Use contact isolation      don’t put on bed or
 precautions                bedstand & disinfect
After removing gown        before leaving room
 don’t touch surfaces that  Teach patients to take
 may be contaminated        ALL of antibiotic
                            presciptions
                         DSH
Ch 46 p.1330




               DSH
Ch46 p.1331




              DSH
Ch 46 p.1332




               DSH
p.1334




         DSH
Immunodeficiency States

Chemotherapy agents or radiation used to
 treat cancers
Immunosuppressive drug regimens for
 chronic diseases or after organ
 transplantation
Malignancies of immune system
Infection with HIV

                   DSH
Clinical Manifestations of
Immunodeficient State
 Decrease in number of WBCs
 Absolute Neutrophil Count ANC
      If ANC < 1000/mm inc. risk
      If ANC < 500 then considered
  neutropenic & will develop infection
 With HIV at risk for infections from
  organisms usually controlled by
  macrophage - activated T lymphocytes
  like viruses, fungi (Candida),
  Mycobacterium DSH
Collaborative Management

Goal - to prevent &
 treat infection
To monitor for signs
 of infection & side
 effects of antiinfective
 drug therapy
Will have orders to
 measure blood levels
 of drugs - peak &
 troughs
                            DSH
Assessments for Infection
in Immunodeficiency
                              Skin/ mucous
Systemic - temp               membranes -
 changes, chills,              inflammmation,
 irritability, inc. pulse,     petechiae, drainage,
 dec. blood pressure           ulceration or tears
Respiratory - cough,         GI - N&V, change in
 sputum or breath              stool or blood
 sound changes
                              GU - frequency,
Eyes - redness,               urgency, pain,
 itching, drainage             change in urine
                           DSHsee p.1340
PLANNING

Don’t assign immunosuppressed patient
 to same nurse that is caring for patient
 with active infection
 Don’t assign staff person who is showing
 signs of infection to this patient




                    DSH
NURSING MEASURES
Protective isolation & careful
 handwashing
Report any sign of fever & collect
 specimens for culture & sensitivity
Oral hygiene & skin care
Nutrition - small, frequent high-protein
 & calorie meals; no RAW foods
Ed - avoid crowds & ill friends; take
                     be
 meds as ordered; DSH immunized
THE CHANGING FACE OF
HIV INFECTION




   WHAT WILL 2001 BRING?
AIDS - Acquired Immune
Deficiency Syndrome
 Case definition         HIV infection is
  dictated by CDC          actually the problem
 Impaired immune         Virus that grows
  system infected with     inside living cells
  HIV causes a cluster Damage takes years
  of problems called       not days or weeks
  AIDS                     like a typical viral
 Data suggests that       illness
  50-90% of HIV           Infectious disease
  persons will develop     acting like a chronic
  AIDS < 10 years          disease
  after being infected DSH
Ch 48 p.1351




               DSH
HIV Infection
 Infects helper T          Infected cell
  lymphocytes                produces new viral
  (T4/CD4 cells)             RNA which
 Attaches to receptor       generates virus &
  on cell & releases its     protein parts
  genetic material          Enzyme, PROTEASE
 Enzyme, REVERSE            cuts viral protein
  TRANSCRIPTASE              into shorter pieces
  converts viral RNA        Newly milled
  into DNA                   proteins form new
 Enzyme,                    HIV capsules
  INTEGRASE splices         HIV capsules bud
  viral DNA into host        away to infect other
  chromosomes
                         DSH
                             cells
DSH
General Transmission of
HIV *

Through body fluids with HIV-1 or CD4+
 T lymphocytes
Serum
Seminal fluid
Vaginal secretions
Amniotic fluid
Breast milk

                   DSH
THE STAGES OF HIV DISEASE
INITIAL EXPOSURE - virus invades; no
 symptoms & normal lab tests(2-6 wks)
ACUTE INFECTION - resembles flu-like
 illness with fever, fatigue, muscle aches
 (resolves in 1-2 wks) may still test neg
ASYMPTOMATIC - no signs; test
 positive to antibody test
EARLY HIV DISEASE - immune system
 begins to malfunction; inc. lymph
 nodes, thrush, hairy leukoplakia, sweats
ADVANCED HIV DISEASE - CD4<200,
 opportunistic infections, malignancies
                     DSH
DSH
SCREENING TESTS FOR
HIV
DETECT HIV-SPECIFIC ANTIBODY
Delay of 3 weeks to 6 months
ELISA or EIA ( Enzyme- Linked
 Immunosorbent Assay)
If EIA is + x2 then Western Blot (WB)
 or Immunofluorescence Assay (IFA) is
 done
If blood is reactive in all 3 steps then it
 is reported as HIV POSITIVE
Other tests: PCR for DNA; Viral culture
                     DSH
DSH
HIV TESTING

WINDOW PERIOD - represents time
 between the infection by HIV & detecting
 the disease by antibody assay; generally
 2-6 weeks




                    DSH
VIRAL LOAD OR BURDEN

A more direct measure of disease
 progression
The amount of HIV RNA in plasma
Reported in copies per ml
< 10,000 copies/mL LOW RISK
10,000-100,000 copies MODERATE RISK
> 100,000 copies HIGH RISK

                  DSH
REVERSE TRANSCRIPTASE
INHIBITORS
AZT OR ZDV                  ddI Didanosine or
 Zidovudine or                Videx
 Retrovir was the first      ddC Zalcitabine or
 antiviral available          HIVID
IT IS NOT A CURE!!          d4T Stavudine or
Watch for anemia &           Zerit
 granulocytopenia            3TC Lamivudine or
q 4 hr dosing                Epivir
                             Nevirapine or
                          DSH
                              Viramune
PROTEASE INHIBITOR
CHALLENGES
 Combination therapy
  needed
 Tremendous COSTS-
  $15,000-25,000/ yr.
 Resistance & cross-
  resistance possible
 MUST take on time,
  follow dietary
  guides, use “drug
  holiday”, watch drug
  interactions         DSH
OPPORTUNISTIC INFECTIONS
PROTOZOAL INFECTIONS -
 pneumocysitis carinii pneumonia,
 toxoplasmosis, cryptosporidiosis
FUNGAL INFECTIONS - Candida
 albicans, cryptococcosis, histoplasmosis
BACTERIAL INFECTIONS -
 mycobacterium avium-intracellulare
 complex (MAC), mycobacterium
 tuberculosis (MTB)
VIRAL INFECTIONS - herpes simplex,
 varicella-zoster, cytomegalovirus (CMV)
                     DSH
Wasting Syndrome of AIDS




            DSH
MALIGNANCIES

KAPOSI’S SARCOMA - most common
 tumor; vascular hyperplasia; lesions
 appear on skin, oral cavity, lungs
 intestines & can vary from purple, dark-
 red, to black
LYMPHOMAS
WASTING DISEASE OR SYNDROME -
 profound weight loss> 10% body weight
                    DSH
Rate of Infection in
Alabama
                         24-44 age group is
1987- 183 cases          most at risk for HIV
     60% WMSM             development
     30% Black           Trends show MSM &
     10%Hemophiliac       IVDU declining;
5 year downward          heterosexual contact
 trend in Alabama         risk increasing
30% cases now           Probably > 7500
 female                   persons in Alabama
HIV/AIDS rate            living with HIV & >
 increasing in blacks     50% have had it for
                          > 5 years
                      DSH
HOW CAN YOU BECOME
INFECTED WITH HIV?
Sexual Contact - contact with semen,
 vaginal secretions, blood that is infected
IV Drug Use - sharing needles & blood;
 also clouded judgment about sex
Perinatal Transmission - 9-25% of
 infants born to infected mothers will
 develop HIV; can happen in utero, at
 birth, or in breast milk
Blood Transfusion (before 1985)
                     DSH
Activities that will NOT put
you at risk for HIV
infection
Giving blood
Sharing food, toilet, spa, insects
Household interaction ( without sexual
 contact or sharing of body fluids )
Being a friend


                    DSH
HOW CAN WE PREVENT
AIDS?
Become evangelists for prevention
There is NO SAFE SEX !! There is safer
 sex but both heterosexual & homosexual
 sexual practices put persons at risk. THIS
 IS THE MOST COMMON METHOD OF
 TRANSMISSION !
Abstaining is the most effective way but
 barrier use can be helpful.
                    DSH
CONDOM INSTRUCTIONS

Use only latex or polyurethane
 See text for specific application
 instructions - failure due to improper or
 inconsistent use can increase risk
Lubricants must be water- soluble, not oil
 based; no petroleum or baby oil, etc.
5% nonoxynol-9 spermicidal prep does
 have viricidal activity but watch for
 allergic reaction     DSH
DSH
DSH
HIV & HCWS

Estimated for HCWs per year
     39 occupational exposures HIV
     400 HBV infection
     1000 or > HCV infections
According to the CDC nurses accounted
 for 41% of documented occupational HIV
 infections
Average cost of needlestick follow-up -
 $600               NURSING 99, JAN 99
                     DSH
PREVENTION FOR HIV
WITH HCWS

RECOGNIZE THAT THERE IS A RISK
TREAT EVERYONE AS IF THEY ARE
 INFECTED
KEEP THE WET STUFF OFF WITH
 BARRIERS & PROPER WASHING
REMEMBER THAT HABITS ARE
 IMPORTANT & ASK THAT ALL HCWS
 FOLLOW PROTOCOL
                 DSH
CAN YOU REFUSE TO
CARE FOR HIV INFECTED
PERSONS BASED ON
YOUR PERSONAL BELIEFS
?
0.4% chance HIV
 from exposure
1% risk if exposure
 with blood-filled
 hollow bore needle


                       DSH
How do you catch AIDS?
 BLOOD EXPOSURE & SEXUAL CONTACT
 NO EVIDENCE OF OTHER MEANS 0F
  TRANSMISSION AFTER YEARS OF
  TRACKING SINCE 1982
 THIS IS A SEXUALLY TRANSMITTED
  DISEASE
 WATCH
     UNPROTECTED SEXUAL CONTACT
     INJECTING DRUGS
     MOTHER TO INFANT
                 DSH
AIDS - Acquired
Immunodeficiency
Syndrome
Late manifestation of HIV or human
 immunodeficiency virus infection
First recognized in 1981 in the U.S.
Difficult to catch
HIV is not a highly infectious organism &
 thought to be easily inactivated outside
 body with many disinfectants & bleach
Persons with AIDS have problems with
 infections & tumorsDSH
AIDS

Does anyone deserve
 to have this disease?
Can you refuse to
 treat any person
 based on HIV status ?




                         DSH

				
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