M.Anusuya ,B.

Sc(N)
Nursing tutor
KVCN.

INFECTION CONTROL IN NURSING

INTRODUCTION:

Microorganisms exist everywhere: in water, in soil, and on body surfaces such as the skin,
intestinal tract, and other areas open to the outside such as our mouth, upper respiratory tract,
vagina, and lower urinary tract. many organisms are harmless, others are lethal, some are a
normal part of our body. As such, the ones directly involved in providing a biologically safe
environment are none other than the nurses.

INFECTION:

Infection is the growth of microorganisms in body tissue where they are not usually found.

 Infectious agent. such a microorganism is called an infectious agent, or the source, a

germ, a virus or other microbes.
 Asymptomatic. If the microorganism produces no clinical evidence of disease, the
infection is called asymptomatic or subclinical.
 Disease. A detectable alteration in normal tissue function is called disease.
 Virulence. Microorganisms vary in their virulence or their ability to produce disease, the
severity of the diseases they produce, and their degree of communicability.
 Pathogenicity. Pathogenicity is the ability to produce disease; thus, a pathogen is a
microorganism that causes disease.
 Asepsis. Asepsis is the freedom from disease causing microorganism; aseptic technique
is used to decrease the possibility of transferring microorganisms from one place to
another.
  Medical asepsis. Medical asepsis includes all practices intended to confine a specific
microorganism to a specific area, limiting the number, growth, and transmission of
microorganisms.
 Surgical asepsis. Surgical asepsis, or sterile technique, refers to those practices that keep
an area or an object free of all microorganisms; it includes practices that destroys
microorganisms and spores.
 Sepsis. Sepsis is the condition in which acute organ dysfunction occurs secondary to
infection.
TYPES OF MICROORGANISMS:

Four major categories of microorganisms cause infection in humans: bacteria, viruses, fungi, and
parasites.

 Bacteria. bacteria are by far the most common infection-causing microorganisms;

several hundred species can cause disease in humans and can live and be transported
through air, water, food, soil, body tissues and fluids, and inanimate objects.
 Viruses. Viruses consist primarily of nucleic acid and therefore must enter living cells in
order to reproduce; common virus families include rhinoviruses (causes the common
cold), hepatitis, herpes, and human immunodeficency virus.
 Fungi. Fungi includes yeast and molds; Candida albicans is a yeast considered to be
normal flora in the human vagina.
 Parasites. Parasites live on other living organisms; they include protozoa such as the one
that causes malaria, helminths (worms), and arthropods (mites, fleas, ticks).
TYPES OF INFECTIONS:

Infection occurs when newly introduced or resident microorganisms succeed in invading a

part of the body where the host’s defense mechanisms are ineffective and the pathogen causes
tissue damage.

 Local infection. A local infection is limited to a specific part of the body where the
microorganisms remain.
  Systemic infection. If the microorganisms spread and damage different parts of the body,
the infection is a systemic infection.
 Bacteremia. When a culture of a person’s blood reveals microorganisms, the condition is
called bacteremia.
 Septicemia. When bacteremia results in systemic infection, it is referred to as septicemia,
which has become common over time.
 Acute infection. Acute infections generally appear suddenly or last a short time.
 Chronic infection. A chronic infection may occur slowly, over a very long period, and
last months or years.
NOSOCOMINAL AND HEALTH RELATED INFECTIONS:
Nosocomial infections are classified as infections that originate in the hospital, and is a
subgroup of health care associated infections or HAIs.

 Urinary tract. The most common microorganisms in the urinary tract

include Escherichia coli (improper catheterization technique), Enterococcus species
(contamination of closed drainage system), and Pseudomonas
aeruginosa (inadequate hand hygiene).
 Surgical sites. The most common microorganisms in surgical sites
include Staphylococcus aureus including MRSA (inadequate hand
hygiene), Enterococcus species including vancomycin-resistant strains (improper
dressing change technique), and Pseudomonas aeruginosa.
 Bloodstream. The most common bloodstream microorganisms include coagulase-
negative staphylococci (inadequate hand hygiene), Staphylococcus
aureus and Enterococcus species (improper intravenous fluid, tubing, and site care
technique).
 Pneumonia. The most common causative microorganisms
for pneumonia include Staphylococcus aureus (inadequate hand hygiene), Pseudomonas
aeruginosa and Enterobacter species (improper suctioning technique).
CHAIN OF INFECTION:
The chain of infection is made up of six links:
 Etiologic agent. The extent to which any microorganism is capable of producing an
infectious process depends on the number of microorganisms present, the virulence and
potency of the microorganisms, the ability of the microorganisms to enter the body, the
susceptibility of the host, and the ability of the microorganisms to live in the host’s body.
 Reservoir. Reservoirs are sources of microorganisms; common sources are other
humans, the client’s own microorganisms, plants, animals, or the general environment;
a carrier is a person or animal reservoir of a specific infectious agent that usually does
not manifest any clinical signs of the disease.
 Portal of exit from reservoir. Before an infection can establish itself in a host, the
microorganisms must leave the reservoir; common human reservoirs include respiratory
tract , GI tract, urinary tract, reproductive tract, blood, and tissues.
 Method of transmission. After a microorganism leaves its source or reservoir, it requires
a means of transmission to reach another person or host through a receptive portal of
entry; there are three mechanisms: direct transmission, which involves immediate and
direct transfer of microorganisms from person to person through touching, biting, kissing,
or sexual intercourse; indirect transmission may be either vehicle-borne (any substance
that serves as an immediate means to transport and introduce an infectious agent into a
susceptible host through a suitable portal of entry) or vector-borne (an animal or flying
or crawling insect that serves as an intermediate means of transporting an infectious
agent); airborne transmission may involve droplets or dust such as a droplet nuclei (the
residue of evaporated droplets emitted by infectious host such as someone
with tuberculosis, can remain in the air for long periods
 Portal of entry to susceptible host. Before a person can become infected,
microorganisms must enter the body; often, microorganisms enter the body of the host by
the same route they used to leave the source.
 Susceptible host. A susceptible host is any person who is at risk for infection; a
compromised host is a person at increased risk, an individual who for one or more
reasons is more likely than others to acquire an infection.
DEFENCE AGAINST INFECTION:
Individuals have defenses that protect the body from infection; they are categorized as
specific and non specific defenses.
 NONSEPTIC DEFENCES:
Nonspecific defenses protect the person against all microorganisms, regardless of prior
exposure; they include anatomic and physiologic barriers and the inflammatory response.

Anatomical and physiological barriers:

 Intact skin and the mucous membranes are the body’s first line of defense against
microorganisms.
 The nasal passages have a defensive function: moist mucous membranes and cilia trap
microorganisms, dust, and foreign materials.
 The lungs have alveolar macrophages (large phagocytes); phagocytes are cells that ingest
microorganisms, dead cells, and foreign particles.
 The oral cavity regularly sheds mucosal epithelium to rid the mouth of colonizers.
 The flow of saliva and its partial buffering action help prevent infections; saliva contains
microbial inhibitors, such as lactoferrin, lysozyme, and secretory IgA.
 The eye is protected from infection by tears, which continually wash microorganisms
away and contain inhibiting lysozyme.
 The high acidity of the stomach normally prevents microbial growth.
 The resident flora of the large intestine help prevent the establishment of disease-
producing microorganisms.
 Peristalsis also tends to move microbes out of the body.
 When a girl reaches puberty, lactobacilli ferment sugars in the vaginal secretions,
creating a vaginal pH of 3.5 to 4.5; this low pH inhibits the growth of many disease-
producing microorganisms.
 The entrance to the urethra normally harbors many microorganisms; urine flow has a
flushing and bacteriostatic action that keeps the bacteria from ascending the urethra; an
intact mucosal surface also acts as a barrier.

INFLAMATORY RESPONSES:
 Inflammation is a local and nonspecific defensive response of the tissue to an injurious or
infectious agent; it is an adaptive mechanism that destroys or dilutes the injurious agent, prevents
further spread of the injury, and promotes the repair of damaged tissue.

 First stage: Vascular and cellular responses. There is constriction of blood vessels,
dilatation of small vessels, increased vessel permeability, increased leukocytes, swelling,
and pain; leukocytes begin to engulf the infection.
 Second stage: Exudate production. This stage is characterized by exudation with fluids
and dead cells; serous (clear, part of the blood), purulent (thick, pus with leukocytes), and
sanguineous (bloody).
 Third stage: Reparative phase. The repair of tissues; examples are regeneration (same
tissues), stroma (connective tissues), parenchyma (functional part), and fibrous (scar).

SPECIFIC DEFENSES:

Specific defenses of the body involve the immune system; the immunes response has two
components: antibody-mediated defenses and cellular-mediated defenses.

Antibody-Mediated Defenses

Another name for the antibody-mediated defenses is humoral (or circulating) immunity because
these defenses reside ultimately in the B lymphocytes and are mediated by antibodies produced
by B cells.

 Active immunity. In active immunity, the host produces antibodies in response to natural
antigens (e.g. infectious agents) or artificial antigens (e.g. vaccines); B cells are activated
when they recognize the antigen; they the differentiate into plasma cells; the B cell may
produce antibody molecules of five classes of immunoglobulins: IgM, IgG, IgA, IgD, and
IgE.
 Passive immunity. With passive (or acquired) immunity, the host receives natural (e.g.
from a nursing mother) or artificial (e.g. from an injection of immune serum) antibodies
produced by another source.
Cell-Mediated Defenses

The cell-mediated defenses, or cellular immunity, occur through the T-cell system.

 On exposure to an antigen, the lymphoid tissues release large numbers of activated T-

cells into the lymph system.
 These T-cells pass into the general circulation.
 There are three main groups of T-cells: helper T cells, cytotoxic T cells, and suppressor T
cells.
 Helper T cells help in the function of the immune system.
 Cytotoxic T cells attack and kill microorganisms and sometimes the body’s own cells.
 Suppressor T cells suppress the functions of the helper T cells and cytotoxic T cells.

NURSING MANAGEMENT

Nursing management for infection control include the following:

Nursing Assessment

The nurse obtains the client’s history, conducts physical assessment, and gathers laboratory data.

 History. During the nursing history, the nurse assesses (a) the degree to which the client
is at risk of developing an infection and (b) any client complaints suggesting the presence
of an infection.
 Physical exam. Signs and symptoms of an infection vary according to the body area
involved; for example, sneezing, watery or mucoid discharge from the nose, and nasal
stuffiness commonly occur with an infection of the nose and sinuses; urinary frequency
and cloudy or discolored urine often occur with a urinary infection.
 Laboratory data. Laboratory data that indicate the presence of an infection include the
following: elevated leukocyte count, increases in specific types of leukocytes as revealed
in the differential WBC count, elevated erythrocyte sedimentation rate, urine, blood,
 sputum, or other drainage cultures that indicate the presence of pathogenic
microorganisms.
Nursing Diagnosis

Based on the assessment data, the most appropriate nursing diagnosis are:

 Potential complication of infection: fever.

 Imbalanced nutrition: less than body requirements.
 Acute pain.
 Impaired social interaction or social isolation.
 Anxiety.
Nursing Care Planning and Goals

The major goals are:

 Maintain or restore defenses.

 Avoid the spread of infectious organisms.
 Reduce or alleviate problems associated with the infection.
Implementation

The nurse prevents strategies to prevent infection.

 Preventing nosocomial infections. Meticulous use of medical and surgical asepsis is

necessary to prevent the transport of potentially infectious microorganisms;
 Hand hygiene. It is important for both the nurses’ and the clients’ hands to be cleansed at
the following times to prevent the spread of microorganisms: before eating, after using
the bedpan or toilet, and after the hands have come in contact with any body substances;
for routine client care, vigorous hand washing under a stream of water for 15 to 20
seconds using granular soap, soap-filled sheets, or liquid soap at the beginning of the
nurses’ shift, when hands are visibly soiled, and after using the toilet, is recommended.
 Nutrition. A balanced diet enhances the health of all body tissues, helps keep the skin
intact, and promotes the skin’s ability to repel microorganisms; adequate nutrition
 enables tissues to maintain and rebuild themselves and helps keep the immune system
functioning well.
 Fluid. Fluid intake permits fluid output that flushes out the bladder and urethra, removing
microorganisms that can cause an infection.
 Sleep. Adequate sleep is essential to health and to renewing energy.
 Stress. Excessive stress predisposes people to infections; nurses can assist clients to learn
stress-reducing techniques.
 Immunizations. The use of immunizations has dramatically decreased the incidence of
infectious diseases; it is recommended that immunizations begin shortly after birth and be
completed in early childhood except for boosters.
 Disinfecting. The first links in the chain of infection, the etiologic agent and the
reservoir, are interrupted with the use of antiseptics (agents that inhibit the growth of
some microorganisms) and disinfectants (agents that destroy pathogens other than spores)
and by sterilization; both antiseptics and disinfectants are said to have bactericidal or
bacteriostatic properties; a bactericidal preparation destroys bacteria, whereas a
bacteriostatic preparation prevents the growth and reproduction of some bacteria.
 Sterilization. Sterilization is a process that destroys all microorganisms, including spores
and viruses; four commonly used methods of sterilization are: moist heat (to sterilize with
moist heat, steam under pressure is used because it attains temperatures higher than the
boiling point); gas (ethylene oxide gas destroys microorganisms by interfering with their
metabolic processes); boiling water (this is the most practical and inexpensive method for
sterilizing in the home); and radiation (both ionizing and non-ionizing are used for
disinfection and sterilization.
Infection Prevention and Control

Because it is not always possible to know which clients may have infectious organisms, a set of
guidelines has been established by the CDC and other organizations outlining steps all healthcare
workers must follow to reduce the chances that organisms in blood and potentially infectious
organisms from other body tissues will be transmitted from the client to other individuals.
Standard Precautions

Standard precautions are used in the care of all hospitalized individuals regardless of their
diagnosis possible infection status.

 Designed for all clients in the hospital.

 These precautions apply to (a) blood; (b) all body fluids, excretions, and secretions
except sweat; (c) nonintact broken skin; and (d) mucous membranes.
 Designed to reduce risk of transmission of microorganisms from recognized and
unrecognized sources.
 Perform hand hygiene after contact with blood, body fluids, excretions, secretions, and
contaminated objects whether or not gloves are worn.
 Wear clean gloves when touching blood, body fluids, secretions, excretions, and
contaminated items.
 Wear a mask, eye protection, or face shield if splashes or sprays of blood, body fluids,
secretions, or excretions can be expected.
 Wear a clean, non-sterile, water-resistant gown if client care is likely to result in splashes
or sprays of blood, body fluids, secretions, or excretions; the gown is intended to protect
clothing.
 Handle client care equipment that is soiled with blood, body fluids, secretions, or
excretions carefully to prevent transfer of microorganisms to others and to the
environment.
 Handle all soiled linen as little as possible.
 Place used needles and other “sharps” directly into puncture-resistant containers as soon
as their use is completed.
Transmission-based Precautions

Transmission-based precautions are used in addition to standard precautions for clients with
known or suspected infections that are spread in one of three ways: by airborne or droplet
transmission, or by contact.

Airborne Precautions
Use standard precautions as well as the following:

 Place client in an airborne infection isolation room that has negative air pressure, 6 to 12
air changes per hour, and either discharge of air to the outside or a filtration system for
the room air.
 If a private room is not available, place the client with another client who is infected with
the same microorganism.
 Wear an N95 respirator mask when entering the room of a client who is known to have or
suspected of having primary tuberculosis.
 Susceptible people should not enter the room of a client who has rubeola (measles)
or varicella (chicken pox).
 Limit movement of client outside the room to essential purposes; place a surgical mask
on the client during transport.
Droplet Precautions

Use standard precautions as well as the following:

 Place client in private room.

 If a private room is not available, place the client with another client who is infected with
the same microorganism.
 Wear a mask if working within 1 meter (3 ft) of the client.
 Limit movement of client outside the room to essential purposes; place a surgical mask
on the client during transport.
Contact Precautions

Use standard precautions as well as the following:

 Place client in private room.

 If a private room is not available, place the client with another client who is infected with
the same microorganism.
 Wear gloves as described in standard precautions.
  Wear a gown when entering a room if there is a possibility of contact with infected
surfaces or items, or of the client is incontinent, or has diarrhea, a colostomy, or wound
drainage not contained by a dressing.
 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.
Personal Protective Equipment

All healthcare providers must apply PPE according to the risk of exposure to potentially infective
materials.

Gloves

 Gloves are worn for three reasons: first they protect the hands when the nurse is likely to
handle any body substances; second, gloves reduce the likelihood of nurses transmitting
their own endogenous microorganisms to individuals receiving care; and third, gloves
reduce the chance that the nurses’ hands will transmit microorganism to from one client
or object to another client.
 In all situations, gloves are changed between client contacts.
 The hands are cleansed each time the gloves are removed for two primary reasons: (1) the
gloves may have imperfections or be damaged during wearing so that they could allow
microorganism entry; and (2) the hands may become contaminated during glove removal.
Gowns

 Clean or disposable impervious (water-resistant) gowns or plastic aprons are worn during
procedures when the nurse’s uniform is likely to become soiled.
 Sterile gowns may be indicated when the nurse changes the dressings of a client with
extensive wounds.
 Single-use gown technique (using a gown only once before it is discarded or laundered)
is the usual practice at hospitals.
Face Masks
  Masks are worn to reduce the risk for transmission of microorganisms by the droplet
contact or airborne routes and by splatters of body substances.
 The CDC recommends that masks be worn:
 By those close to the client if the infection is transmitted by large-particle aerosols
(droplet); large particle aerosols are transmitted by close contact and generally travel
short distances (about 1 m or 3 ft).
 By all individuals entering the room if the infection is transmitted by small particle
aerosols (droplet nuclei); small-particle aerosols remain suspended in the air and thus
travel great distances in the air.
Eye Wear

 Protective eye wear (goggles, glasses, face shields) and masks are indicated in situations
where body substances may splatter the face.
 If the nurse wear prescription eyeglasses, goggles must still be worn over the glasses
because the protection must extend around the sides of the glasses.
Sterile Technique

An object is sterile only when it is free of all microorganisms.

 It is well known that sterile technique is practiced in operating rooms and special
diagnostic areas.
 Sterile technique is also employed for many procedures in general care areas such as
when administering injections, changing wound dressings, performing urinary
catheterization, and administering intravenous therapies.
 In these situations, all principles of the surgical asepsis are applied as in the operating or
delivery room; however, not all of the sterile techniques that follow are always required.
Principles of Surgical Asepsis

 All objects used in a sterile field must be sterile.

 Sterile objects become unsterile when touched by unsterile objects.
 Sterile objects that are out of sight or below the waist or table level are considered
unsterile.
 Sterile objects may become unsterile by prolonged exposure to airborne microorganisms.
 Fluids flow in the direction of gravity.
 Moisture that passes through a sterile object draws microorganisms from unsterile
surfaces above or below to the sterile surface by capillary action.
 The edges of a sterile field are considered unsterile.
 The skin cannot be sterilized and is unsterile.