Infection Control

 Aninfection is a disease state that results

from the presence of pathogens (disease-
producing microorganisms) in or on the
body. An infections occurs as a result of a
cyclic process, consisting of six
components

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These components are

1. Infectious agent
2. Reservoir
3. Portal of exit
4. Means of transmission
5. Portal of entry
6. Susceptible host

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Infectious Agent

 Some of the more prevalent agents that cause

infection are bacteria, viruses, and fungi.
 Bacteria, the most significant and most
commonly observed infection-causing agents in
health care institutions, can be categorized in
various ways. They are categorized by shape as
spherical (cocci), rod shaped (bacilli), or
corkscrew shaped (spirochetes).

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 Bacteria are either gram positive or gram
negative, based on their reaction to the gram
stain. For example, gram-positive bacteria have
a thick cell wall that resists decolorization (loss
of color) and are stained violet. However, gram
negative bacteria have chemically more complex
cell walls and can be decolorized by alcohol.
Thus, gram-negative bacteria do not stain.

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 Another distinguishing characteristic of
bacteria is their need for oxygen. Most
bacteria require oxygen to live and grow
and are referred to as aerobic. Those that
can live without oxygen are anaerobic
bacteria.

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A virus
A virus is the smallest of all microorganism,
visible only with an electron microscope. Many
infections are caused by viruses, including the
common cold and the deadly disease, acquired
immunodeficiency syndrome (AIDS). Antiviral
medications that seem to be effective with some
viral infections are available. When given in the
prodromal stage of certain viruses, these
medications can shorten the full stage of the
illness.

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Fungi
 Fungi, plantlike organisms (molds and yeast)
that also can cause infection, are present in the
air, soil, and water. Some examples of infections
caused by fungi include athlete's foot, ring worm,
and yeast infections. These infections are
treated with antifungal medications. However,
many infections due to fungi are resistant to
treatment.

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Factors affecting infection producing
disease
1. Number of organisms
2. Virulence of the organism, or its ability to
cause disease
3. Competence of the person's immune system
4. Length and intimacy of the contact between
the person and the microorganism

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Reservoir

 Reservoir is the term used for any person,

plant, animal, substance, or location that
provides nourishment for microorganisms
and enables further dispersal of the
organism. Infections may be prevented by
eliminating the causative organisms from
the reservoir.

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Mode of Exit

 The organism must have a mode of exit

from a reservoir. An infected host must
shed organisms to another or to the
environment before transmission can
occur. Organisms exit through the
respiratory tract, the gastrointestinal tract,
the genitourinary tract, and the blood.

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Route of Transmission

A route of transmission is necessary to

connect the infectious source with its new
host. Organisms may be transmitted
through sexual contact, skin-to-skin
contact, percutaneous injection, or
infectious particles carried in the air.

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Carrier
A person who carries, or transmits, an
organism and who does not have apparent
signs and symptoms of infection is called a
carrier.

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Susceptible Host

 For infection to occur, the host must be susceptible (ie,

not possessing immunity to a particular pathogen).
Previous infection or vaccine administration may render
the host immune (ie, not susceptible) to further infection
with an agent. Many infections are prevented because of
the powerful human immune defense. Although
exposure to potentially infectious microorganisms occurs
essentially on a constant basis, our elaborate immune
systems generally prevent infection from occurring. The
immune-suppressed person has much greater
susceptibility than the normal, healthy host.

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Mode of Transmission

 Mode of transmission refers to the way in which the organism

moves or is carried from the source's portal of exit. The five main
routes of transmission are contact, vehicle, droplet, airborne, and
vectorborne.
Contact Transmission
 Contact transmission is the most frequent means of transmitting
infections in healthcare facilities. Contact transmission is by direct or
indirect contact.
 Direct contact involves body surface-to-body surface contact
causing the physical transfer of organisms between an infected or
colonized person and a susceptible host. Healthcare personnel can
transfer organisms to clients during care such as bathing, dressing
changes, and inserting invasive devices. Direct transfer also may
occur between two clients, with one acting as the source and the
other as the host.

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 Indirect contact occurs when a susceptible host
is exposed to a contaminated object, such as a
dressing, needle, or surgical instrument.
Vehicle Transmission
 Vehicle transmission involves the transfer of
microorganisms by way of vehicles, or
contaminated items that transmit pathogens.
Food can carry Salmonella, water can carry
Ambiasis, drugs can carry bacteria from
contaminated infusion supplies, and blood can
carry hepatitis and human immunodeficiency
virus (HIV).

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Droplet Transmission
 Droplet transmission occurs when mucous membranes of
the nose, mouth, or conjunctiva are exposed to secretions
of an infected person who is coughing, sneezing, or
talking. Droplets do not remain suspended in the air for
very long and seldom travel more than 3 feet; thus,
transmission is not via the airborne route.
Airborne Transmission
 Airborne transmission occurs when fine particles are
suspended in the air for a long time or when dust particles
contain pathogens. Air currents widely disperse
organisms, which can be inhaled by or deposited on the
skin of a susceptible host.
 .

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Vectorborne Transmission
 Vectors can be biologic or mechanical. Biologic
vectors are living creatures, such as rats or
insects, that carry pathogens. Transmission by
biologic vectors is of great concern in tropical
areas, where mosquitoes transmit diseases such
as malaria. Mechanical vectors are inanimate
objects that are contaminated with infected body
fluids. Examples of mechanical vectors include
contaminated needles and syringes shared by
intravenous (IV) drug users. Both hepatitis B and
HIV commonly are spread in this manner

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Portal of Entry

A portal of entry is needed for the

organism to gain access to the host. For
example, airborne M. tuberculosis does
not cause disease when it settles on the
skin of an exposed host. The only entry
route for the bacterium that is of concern is
through the respiratory system.

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Colonization

 The term colonization is used to describe

microorganisms present without host
interference or interaction. Understanding the
principle of colonization facilitates interpretation
of microbiologic reports. Organisms reported in
microbiology results often reflect colonization
rather than infection.

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Stages of Infection
 An infection progresses through the
following phases:
1. Incubation period
2. Prodromal stage
3. Full stage of illness
4. Convalescent period

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Incubation period

 The incubation period is the interval between the

pathogen's invasion of the body and the
appearance of symptoms of infection. During
this stage, the organisms are growing and
multiplying. The length of incubation may vary.
For example, the common cold has an
incubation period of 1 to 2 days, whereas
tetanus has an incubation period ranging from 2
to 21 days.
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Prodromal stage

A person is most infectious during the prodromal

stage. Early signs and symptoms of disease are
present but these are often vague and
nonspecific, ranging from fatigue and malaise to
a low-grade fever. This period lasts from several
hours to several days. During this phase, the
patient often does not realize that he or she is
contagious. As a result, the infection spreads.

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Full stage of illness

 The presence of specific signs and symptoms

indicates the full stage of illness. The type of
infection determines the length of the illness and
the severity of the manifestations. Symptoms
that are limited or occur in only one body area
are referred to as localized symptoms, whereas
symptoms manifested throughout the entire
body are referred to as systemic symptoms

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Convalescent period

 The convalescent period is the recovery period from the

infection. Convalescent may vary according to the
severity of the infection and the patient's general
condition. The signs and symptoms disappear, and the
person returns to a healthy state. However, depending
on the type of infection, the person may have a
temporary or permanent change to his or her previous
health state even after the convalescent period.
 A person may continually pass through the four phases
with the same infectious process, such as herpes
simplex.

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Manifestations of Infection
Fever, a common manifestation of infection, should be
considered a sign of infection until other causes are
ruled out. Fever is the hypothalamic thermoregulatory
center's response to circulating pyrogens. These
pyrogens are released when phagocytic cells
(macrophages) are stimulated by microorganisms or
endotoxins. A low-grade fever is a temperature that is
slightly elevated (37.1°C to approximately 38.2°C [98.8°F
to 100.6°F]).

A temperature elevation above 38.2°C is considered a

high-grade fever, and a temperature greater than 40.5°C
(104.9°F) is referred to as hyperpyrexia. Very young
children tend to produce high fevers with infection (up to
40°C [104°F]), but older people may not show a fever or
may produce only a low-grade fever when infection is
present.
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Increased Pulse and Respiratory Rate
Infection increases the body's metabolic rate, which
increases the heart rate. The pulse may become
bounding. The rate and depth of respiration also
increase as the body attempts to rid itself of excess
waste produced during increased metabolism.

Purulent Drainage
As WBCs migrate to the infection, purulent (containing pus)
drainage may be observed. Because of the increased
numbers of WBCs, body fluids such as urine or sputum
may become cloudy or whitish-yellow. Purulent drainage
is usually thicker than normal, and it often is foul smelling
because it contains a great deal of cellular debris from
the inflammatory response.
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Enlarged Lymph Nodes
During an infection, the lymph nodes that drain an infected area may
become enlarged and easily palpable (“swollen glands”). As the
swelling increases, the nodes may also become tender. During
inflammation, the lymphatic capillaries dilate as excess interstitial
fluid, proteins, and invading microorganisms enter the lymphatic
system. The swelling indicates that lymphocytes and macrophages
in the lymph node are fighting the infection and trying to limit its
spread.

Rash
A rash may occur with primary infections of the skin (e.g., impetigo) but
also may accompany some generalized infectious diseases. The
diagnosis of many communicable childhood diseases is made on
the specific characteristics of the rash. Many rashes cause pruritus
(itching). Scratching may disrupt the skin's integrity, possibly
resulting in secondary skin infections.

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The body's Defense against Infection

 The inflammatory response is a protective mechanism

that eliminates the invading pathogen and allows for
tissue repair to occur. Inflammation helps the body to
neutralize, control, or eliminate the offending agent and
prepare the site for repair.

 Another defense system is the immune response. The

immune response involves specific reaction in the body
as it responds to an invading foreign protein, such as
bacteria, or in some cases, to the body's own proteins.
The complex mechanisms that constitute the immune
response occur as the body attempts to protect and
defend itself.
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 The foreign material is called antigen by
producing an antibody. This antigen-
antibody reaction, also known as humoral
immunity, is one component of the overall
immune response. The cell-mediated
defense, or cellular immunity, involves an
increase in the number of lymphocytes
(white blood cells) that destroy or react
with cells the body recognizes as harmful.

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Factors Affecting the Risk for Infection

The susceptibility of the host depends on

various factors:
1. Intact skin and mucous membranes protect the
body against microbial invasion.
2. The normal pH levels of the gastrointestinal
and genitourinary tracts, as well as the skin,
help to ward off microbial invasion.
3. Age, sex, race, and hereditary factors influence
susceptibility. Neonates and older adults
appear to be more vulnerable to infection.
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4. Immunization, natural or acquired, acts
to resist infection.
5. Fatigue, climate, nutritional and general
health status, the presence of preexisting
illnesses, previous or current treatments,
and certain medications may play a part
in the susceptibility of a potential host.
6. Stress may adversely affect the body's
normal defense mechanisms.

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7. The increasing use of invasive or indwelling
medical devices provides exposure to and
entry for more potential sources of disease-
producing organisms, particularly in a patient
whose defenses are already weakened by
disease.
8. Health habits that promote wellness can
decrease the susceptibility of a host. Sensible
nutrition, adequate rest and exercise, stress-
reduction techniques, and good personal
hygiene habits can maintain optimum bodily
function and immune response.

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The Nursing Process for Infection Control
and Prevention

Assessing

1. Patient History
2. Immunization
3. Previous or recurring infection

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4. Assess signs of localized infection such as
redness, swelling, warmth in the involved area,
pain or tenderness, and loss of function of the
affected part.
5. Assess signs of a systemic infection include
fever, often accompanied by an increase in
pulse and respiratory rate, lethargy, anorexia,
and tenderness and enlargement of lymph
nodes that drain the area when an infection is
present.
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Isolation Systems

Isolation refers to techniques used to prevent or to limit the

spread of infection. Universal Precautions relate to blood
and certain body fluids to protect healthcare workers
from clients possibly carrying HIV, hepatitis B virus, or
other blood borne pathogens. Body substance isolation
involves the use of barriers to provide protection from all
moist body secretions. In 1995, the CDC introduced
guidelines for a new two-tiered system of isolation
precautions that includes Standard Precautions and
Transmission-Based Precautions.

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Standard Precautions and Transmission-Based
Precautions. Standard Precautions for all clients
to protect against blood and body fluid
transmission of potential infective organisms

Transmission-Based Precautions to protect

against the spread of highly transmissible or
epidemiologically significant pathogens in clients
with documented or suspected infection.

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