INFECTION CONTROL/PREVENTION

IMMUNITY & DISEASES FAITH VAUGHN RN, BSN, MSN

IMMUNITY
Immunizations are: Artificial defenses that protect against specific pathogens Artificial or weakened antigens that help the body develop protective antibodies Vaccines that can prevent most childhood diseases such as measles, rubella (German measles), meningitis, mumps, polio, diphtheria, chickenpox, whooping cough, and tetanus

IMMUNITY (CONTD)
Active immunity: exposure to a disease organism triggers the immune system to produce antibodies to that disease. There are 2 types:

Natural active: antibodies develop during infection with the actual disease. (measles, chickenpox) Artificial active: introduction of a killed or weakened form of disease organism thru vaccines (MMR, Hep B, polio)

IMMUNITY (CONTD)
Passive immunity: person is given antibodies to a disease. There are 2 types: Natural passive: mother to child thru placenta or milk Artificial passive: used during potentially fatal diseases. Provides an instant response of temporary antibodies (tetanus, gamma globulin) Protection for active immunity is permanent and takes several weeks to become active Passive immunity is temporary and acts immediately

BACTERIAL/VIRAL INFECTIONS
Immunosuppression: Occurs when the bodys immune system is inadequate. A number of factors can lead to this condition, including: Advanced age and Frailty Chemotherapy Infection with Human immunodeficiency virus (HIV) Radiation therapy

BACTERIAL INFECTIONS (CONTD)

Methicillin-resistant Staphylococcus aureus (MRSA): Is a virulent staph infection, normally found on skin and mucous membranes. Resistant to antibiotic treatment, and can prove fatal very quickly Vancomycin-resistant enterococci (VRE): Entero-cocci are found in the gastrointestinal tract. Major cause of infections acquired in health care facilities. Most strains are highly resistant to many antibiotics. Newer strains are resistant to vancomycin

BACTERIAL INFECTIONS CONTD

Streptococcus A: Is a bacterium that produces very powerful enzymes that destroy tissue and blood cells. Infection is pass on to others by coughing or sneezing, touching environmental surfaces without washing your hands. Strep A infection occurs when bacteria enters the body through minor trauma or a break in the skin Good hand washing helps reduce the risk of infection. Treatment with antibiotics and surgery, the results are not always good

BACTERIAL INFECTIONS (CONTD)

Clostridium difficile (C.diff) is a bacterium which causes diarrhea > develops after a series of antibiotic therapy. > affects the lining of the intestine, causing inflammation. > results in sudden, severe, foul-smelling, watery diarrhea. More commonly acquired in hospitals Escherichia coli: commonly found in the intestinal tract (feces). A small amt of this bacteria can contaminate meat, especially ground beef Salmonella: a group of bacteria that cause mild to life threatening intestinal infection (food poisoning)

BACTERIAL INFECTIONS (CONTD)

Precautions: Wash your hands regularly with soap and water before and after patients care, and removal of gloves Wear gloves and gown when coming in contact with infectious material Encourage visitors to wash their hands before and after patients visit to ensure that they dont carry germs Carry alcohol wipes and extra gloves to use between patients Remove gown and gloves and dispose of them appropriately as per policy, outside of patients room Have visitors report to the nurses station before entering room

TUBERCULOSIS INFECTION
Tuberculosis (TB): is an infectious disease caused by the organism Mycobacterium tuberculosis (tubercle bacilli) Tubercle bacilli: are spread by airborne droplets expelled when a person with active TB coughs, sneezes, or talks Individuals exposed to contaminated air may breathe in the organism. This is more likely to occur in poorly ventilated or closely confined spaces (vehicles, trains, crowded areas)

TUBERCULOSIS INFECTION (CONTD)

TB: an increase in the number of people who are at risk, including those who are: HIV positive Infected but fail to take their meds Live in poverty and are malnourished Immigrants to the United States from countries where TB is still common Have had inactive TB but have grown older and experience increased disability

TUBERCULOSIS INFECTION (CONTD)

Latent TB: An estimate of 10 to 15 million people in the U.S. have latent TB infection A person infected and has a strong immune system, is able to contain the infection and will not become ill with the disease. Persons are not contagious (cannot transmit TB infection to others Only 1 in 10 persons with latent TB infection will ever develop active TB, as long as they are HIV negative

TUBERCULOSIS INFECTION (CONTD)

Active TB: occurs when an individuals immune system fails to keep the TB organism contained Can involve almost any organ in the body, but is most commonly spread from person to person when lungs or airways are involved Airborne precautions are required (mask, negative pressure room) until three consecutive Acid Fast Bacilus (AFB) sputum smears are negative

TUBERCULOSIS INFECTION (CONTD)

Signs/symptoms of TB: as disease progresses, the person will show one or more symptoms: Fatigue Loss of appetite and weight Weakness Elevated temp in the afternoon and evening Night sweats Spitting up blood (hemoptysis) Coughing

TUBERCULOSIS INFECTION (CONTD)

TB diagnosis: the presence of TB bacterium in the body can be shown by: A sputum culture: grows the organisms from a specimen of secretions from the persons lungs Chest X-rays: show the extent of the disease process in the lungs A positive skin test (Mantoux test) shows the presence of antibodies to the TB organisms in the body, and is not an indication of the active disease Most health care workers must undergo a skin test for TB before employment

TUBERCULOSIS INFECTION (CONTD)

TB treatment/prevention A person with TB is treated with a selected antibiotic or combination of antibiotics Once drug therapy starts, the patient usually becomes noncontagious (cannot spread the disease organism) within two to three weeks Cure for TB requires 6-12 months, or longer, of continuous treatment The course of treatment must be completed to avoid recurrence All new TB and suspected cases should be reported promptly to the Health Department by the health care provider, as required by the state

AIDS AND HIV

Acquired Immune Deficiency syndrome (AIDS), which is a serious condition that affects the bodys ability to fight infections AIDS is caused by the Human Immunodeficiency Virus (HIV) HIV in the body, can destroy the immune cells (T-cells and white blood cells) that defend the body against infections Without these cells, the body cannot defend itself from illness Disease and infections can now move into the body without a fight

AIDS AND HIV (CONTD)

HIV can be transmitted by: Blood and plasma Semen Vaginal secretions Cerebrospinal fluid Bone marrow Sharing injection needles or syringes Placenta Breast milk Body fluids containing blood Body tattooing/piercing

AIDS AND HIV (CONTD)

HIV cannot be transmitted by: Shaking hands Coughing A dry kiss Swimming pools Sharing food Donating blood Hugging Sneezing Toilet seats or rest rooms Sharing eating or drinking utensils Insects, including mosquitos Door knobs Sweat, saliva, or tears

AIDS AND HIV (CONTD)

HIV tests and treatment: Most widely used test is the enzyme-linked immunosorbent assay (ELISA) test Positive results, the test is repeated. After two positives, a Western Blot Test is done to confirm the results No cure for AIDS and no vaccine available for HIV. Antiretroviral therapy, which is known as cocktail drugs, combination therapy, or highly active antiretroviral therapy (HAART). Each type of drug fights HIV differently to slow down the spread of the HIV virus (combivir, invirase, atripla, norvir)

AIDS AND HIV (CONTD)

Stages of the Disease: Person who is exposed to HIV develops antibodies to the virus within 2 24 weeks (window period) Stage 1: Newly exposed persons may exhibit flu like symptoms that may last one to two weeks Stage 11: symptoms such as weight loss, night sweats, fevers, swollen lymph nodes, dry persistent cough, oral candidasis (thrush), and fatigue Stage 111: T cell count is below 200/m3 (normal T Cell count in a healthy adult is 800-1000) Stage 11 symptoms with one or more opportunistic infections are present (Kaposis Sarcoma, pneumocystis carinni) develops

AIDS AND HIV (CONTD)

Standard precautions: Assume that all blood and bodily fluids are contagious Use appropriate Personal protective Equipment (PPE) (mask, gown, gloves, or goggles) when appropriate Dispose of blood, body fluids, and contaminated materials in the appropriate containers such as (red bags, needle/sharps boxes) Do not touch broken glass with your hand. Use forceps or tongs to dispose of glass

AIDS AND HIV (CONTD)

Standard precautions: Keep all cuts and breaks on skin covered with a band-aid, and wear disposable gloves Disinfect surfaces contaminated with blood or body fluids using 1:10 bleach solution Do not eat, drink, smoke, or apply cosmetics or lip balms in areas where there may be blood or body fluids Do not store food or drink in refrigerators where blood or body fluids may be present Practice hand hygiene frequently and thoroughly, even after using gloves

HEPATITIS A
Hepatitis A virus (HAV) is most common and transmitted by: Feces, saliva, and contaminated food Symptoms: Yellowish color of skin (jaundice) and sclera, fever, nausea, vomiting, diarrhea, fatigue, abdominal pain, dark urine, and appetite loss. respiratory symptoms, rashes, and joint pain Treatment: Vaccine available Rarely fatal Bedrest and avoidance of alcoholic beverages Precautions: wash hands before and after handling food, wash fruits and vegetables thoroughly

HEPATITIS B (CONTD)
Hepatitis B virus (HBV) Causes inflammation of the liver Tissue response to virus may be mild, flu-like, or so severe as to cause hospitalization HBV may be present in blood and body fluids such as: Bloody saliva contacted during dental procedures Blood Semen Vaginal secretions Cerebrospinal fluid Synovial fluid (fluid lubricating the joints)

HEPATITIS B (CONTD)
Full immunizations: Requires three doses of vaccines over a 46 month period Personnel screened for the hepatitis B surface antibody, after the immunization is completed (blood test to determine titer levels) Incidence of side effects to the vaccine is very low Effective at providing protection against the Hep B virus Vaccine is available at no cost through the Employee Health Department

HEPATITIS B (CONTD)
Accident exposure to blood and body fluids: You must be evaluated and treated by the employee health department within four hours of exposure If the employee health department is closed, you should go to the emergency room within the same time frame of less than four hours of exposure

Facility will provide upon consent, a confidential medical evaluation including blood tests, postexposure prevention treatment and follow-up counseling

HEPATITIS C (CONTD)
Hep C virus (HCV Transmitted through blood and blood products May be mistaken for the flu Common signs and symptoms include: Fatigue Depression Fever Mood changes Weakness Pain and Loss of appetite May cause liver cancer and liver failure

HEPATITIS C (CONTD)
Protect yourself by: Using standard precautions Taking the vaccine, if available

Practicing safe sex (using condoms)

Not using illegal drugs Giving your full attention to the handling of sharps such as needles or razors

PREVENTING INFECTION
Assist patients to maintain adequate fluid intake Wipe from front to back when cleaning perineal area Observe patient carefully and report to the nurse: > changes in frequency of urination > complaints of pain/burning on urination > coughing or respiratory problems > confusion or disorientation that is unusual > drainage or discharge from any body opening or wound > changes in skin color > complaints of pain, discomfort or nausea > elevated temp, red, swollen areas on body