Any disease-causing micoorganism (pathogen).
Exogenous infection example
Normal flora on skin enter body through cut/incision and cause an infection.
Endogenous infection example
Patient put on broad-spectrum antibx and develops C.diff infection.
Entry and multiplication of an organism into a host that typically results in clinical sx.
Microorganisms present in tissue but don't cause infection.
The organism in which the infectious microbes reside.
What is the most common reservoir?
Human body - skin, body cavities, fluids, and discharges.
Person who carries and spreads disease.
First stage of infection: organism has gained entry but host unaware (no sx).
Second stage of infection: immediately before illness and host experiences vague sx of disease.
Third stage of infection: host manifests sx of disease (strep - sore throat, pain & swelling).
Fourth stage of infection: recovery.
Chicken pox incubation time
Common cold incubation time
Influenza incubation time
Mumps incubation time
Portal of exit
Route of escape of the pathogen from the reservoir (i.e., respiratory secretions, blood exposure, breaks in skin).
Route of transmission
Method by which pathogen gets from reservoir to new host (i.e., contact, droplet, airborne, vector).
Large particles that travel up to 3' via sneezing, coughing or talking (i.e., Influenza, rubella, bacterial meningitis).
Small particles that have ability to stay suspended in air via coughing or sneezing (i.e., TB, chicken pox, measles).
Physical contact between source and susceptible host (i.e., Hep A, Shigella, Staph).
Living creatures & insects that transmit causative agent from infected to uninfected (i.e., West Nile, malaria, plague, Lyme).
Portal of entry
Route through which pathogen enters new host (i.e., mucous membranes, GI, GU, mouth).
Caused by medical intervention (HAI).
Organism that accepts the pathogen; depends on degree of host's resistance.
Infants & elderly (immunocompromised)
Normal immune response to acute infection:
Short-term and relatively severe course.
Normal immune response to chronic infection:
Long-term and may last a lifetime (i.e., HBV, HIV, HPV) with intermittent tx when acute flare occurs.
Normal immune response to systemic infection:
Not easily identified, generally involves whole body resulting in fever, fatigue, HA (cardinal response).
Normal immune response to local infection:
Confined to identified site and exhibit heat, redness, swelling and pain.
Pathophysiology of inflammation
1. Pathogens enter wound.
2. Platelet release clotting proteins at site.
3. Mast cell secretions cause vasodilation - swelling.
4. Neutrophil secretions kill/degrade pathogens (phagocytosis).
5. Macrophage secretions attract immune system cells and activate tissue repair cells (cytokines).
6. Inflammatory response continues until pathogens eliminated and wound repaired.
SIRS (Systemic Inflammatory Response Syndrome)
Criteria 2 or more present:
1. Temp 100.4+ or <96.8
2. HR > 90 bpm
3. RR > 20
4. WBC < 4000 or > 12,000 or 10% immature bands
= SIRS criteria + known or suspected infection (i.e., purulent sputum and CXR infiltrate consistent with pneumonia, pyruia (WBC in urine), abcesses, skin or soft tissue infection, abnormal abdominal assessment (pain, incision, drain, distention, etc.))
Sepsis + hypoperfusion or decreased organ function: 1 or more present:
1. Lactate > 2 mmol/dl
2. SBP < 90 mmHg
3. MAP > 65 mmHg
4. Acutely altered mental status
5. SaO2 < 90%
6. Mottled skin - decreased cap refill
7. New onset oliguria UOP <0.5 ml/kg/hr
8. Platelets <100,000
Severe sepsis cascade
1. Injury (release of toxins from bacteria causes)
2. Inflammation (suppressed fibrinolysis)
3. Damage to BV
4. Coagulation (suppressed fibrinolysis)
5. Endogenous protein C (modulates coagulation, controls inflammation, and supports fibrinolysis) decreased
6. Abnormal clotting
7. Tissue injury
8. Organ failure
1. Serum lactate measured
2. Blood cultures obtained prior to antibx tx
3. Reduced time to broad-spectrum antibx
4. Tx hypotension and/or elevated lactate with fluids
5. Apply vasopressors for ongoing hypotension
6. Maintain adequate CVP
7. Maintain adequate central venous O2 sat
When must resuscitation bundle be started?
When patient recognized as septic.
When must resuscitation bundle be completed?
Within 6 hours.
Separates those exposed to illness (not sick or have sx) from others (i.e., SARS, Smallpox, Measles, Cholera, Plague, Anthrax, Scarlet Fever, Typhoid, Hemorrhagic fever, TB).
Separates those ill/infected from those not.
1. Hand hygiene
2. PPE: gloves, gowns, mouth/nose/eyes protection
3. Respiratory hygiene
4. Patient placement
Examples of when to use standard precautions:
2. Abscess with minor drainage
1. Standard precautions
2. Patient placement: single pt room, prioritize pts, cohorts (same dx), avoid at risk placement
3. PPE: gowns & gloves; don at entry to room
4. Patient transport: Limit outside time, pt wears PPE (remove dirty PPE before transport and don clean at destination)
Examples of when to use contact precautions:
1. MRSA, VRE, VRSA
2. Pediculosis (head lice)
5. C. diff gastroenteritis
1. Standard precautions
2. Patient placement: single pt room, prioritize pts, cohorts, avoid at risk placement
3. PPE: gowns, gloves & mask; don at entry to room
4. Patient transport: Limit outside time, pt wears mask & follows cough etiquette
Examples of when to use droplet precautions:
3. Epiglottis due to Hib
5. Season influenza
6. Pandemic influenza
1. Standard precautions
2. Patient placement: negative air
3. Personnel restrictions: only immune known able to care for pts
4. PPE: N95 respirator; don at entry
5. Patient transport: Limit outside, pt wear surgical mask & follow cough etiquette and cover lesions
Examples of when to use airborne precautions:
1. Chicken pox
1. Patient placement: positive pressure/HEPA filtration
2. Prohibit dried & fresh flowers/potted plants (bugs)
3. Minimize outside of room time
4. Standard precautions
Examples of when to use protective isolation:
2. Stem cell transplant
3. Immunocompromised (HIV)
5. Organ transplant
What will RN monitor during general infections?
1. Assessments of portals of entry
2. Monitoring increased VS (temp, pulse & RR)
3. Monitoring labs (C&S, sed rate - level of inflammation, titers)
4. Monitoring diagnostics looking for damage at site
Predict the unique psychosocial needs of the isolated patient.
5. Social interaction