FUNDAMENTALS OF NURSING - INFECTION CONTROL : PART TWO

CCBC Definition  Activities used to minimize the spread of microorganisms which can cause disease FUNDAMENTALS OF NURSING - INFECTION CONTROL : PART TWO 9/12/2020 2 Objectives 1. Differentiate between Hospital Acquired Infections and Community Acquired Infections 2. Describe the uses, mechanisms of action, side effects, adverse reactions, and nursing implications for the following groups of antibiotics: Penicillins, Cephalosporins, Macrolides, Tetracyclines, Aminoglycosides, Fluoroquinolones, Sulfonamides, and Glycopeptides 3. Discuss the nursing interventions for antibiotic drugs Community Acquired Infections Hospital Acquired Infections  Occurred outside of the hospital setting  Hospitalization 48 hours  Patients otherwise healthy  Occurs spontaneously Infection classification  Occurred in the hospital setting  Hospitalization 48 hours  Typically immune defense is impaired  Often associated with a medical device or medical procedure  Intragenic infection: hospital acquired infection caused by a medical accident 9/12/2020 3 Health-care associated infections (HAIs)  Infections that patients acquire while receiving care in a healthcare setting  Formerly called nosocomial infections  The BEST WAY to prevent HAIs: Frequent and effective hand-hygiene  Types of infections:  Central Line Associated Bloodstream Infection (CLABSI)  Catheter-Associated Urinary Tract Infections (CAUTI)  Surgical site infection (SSI)  Ventilator-Associated Pneumonia (VAP)  Occurs when bacteria or viruses enter the bloodstream through central venous catheter  Central lines provides direct access to the heart through a major vein close to the heart, and can remain in place for weeks or months  Central lines are used for:  CVP monitoring  Vasopressors  Lack of IV access  TPN  Guidelines to follow when inserting a central line:  Perform hand hygiene  Apply appropriate skin aseptic  Ensure the skin prep agent has completely dried prior to inserting the catheter  Use: sterile gloves, sterile gown, cap, mask, large sterile drape  Guidelines to follow once a central line is in place:  Follow recommended hospital guidelines  Wash hands with soap and water or an alcohol based hand rub before touching the line Central Line Associated Bloodstream Infections (CLABSI) 9/12/2020 4 Catheter -Associated Urinary Tract Infections (CAUTI)  Occurs when bacteria enters the urinary tract via a urinary catheter and causes an infection  CAUTIs have been associated with an increased morbidity, mortality, healthcare costs, and length of stay  Bacteria that most commonly cause UTIs are:  Escherichia coli  Staphylococcus aureus  Enterococci  Guidelines to follow when inserting an urinary catheter:  Perform hand hygiene  Use: sterile gloves, drape, sponges, aseptic solution for periurethral cleaning  Properly secure indwelling catheter after insertion to prevent movement and urethral traction  Use the smallest bore catheter possible to prevent trauma  Guidelines to follow after the urinary catheter is in place:  Follow recommended hospital guidelines Surgical site infection (SSI)  An infection that occurs after surgery in the area in which the surgery took place  Can be either superficial involving only the skin or more serious involving tissues underneath the skin, organs, and other implanted material  Actions to prevent infection:  Wash hands and arms to the their elbows with an antiseptic agent prior to surgery  Wash hands or use an alcohol-based hand rub before and after caring for each patient  Clip or shave hair in the area where the procedure will occur  To keep surgical area clean, wear special hair covers, masks, gowns, and gloves during surgery  If indicated, administer antibiotics within 60 minutes before surgery starts and the antibiotics should be stopped within 24 hours after surgery  Clean surgical area with a special soap that kills germs (e.g. Cholrhexadine) 9/12/2020 5 Ventilator associated pneumonia (VAP)  Lung infection that develops in a person with a ventilator  A ventilator is a machine that provides oxygen via a tube placed in the patient’s nose, mouth, or hole in the front of the neck  Actions to avoid VAP:  Keep the head-of-bed raised between 30-45 degrees unless other medical conditions prevent elevation  Perform daily checks to assess the patient’s ability to breathe on his or her own so, the patient can be taken off the ventilator as soon as possible  Wash hands or use an alcohol-based hand rub before and after touching the patient or the ventilator  Regularly wash the patient’s mouth  Clean or replace patient equipment before using on another patient “Other HAIs” ( can also occur in the community)  MRSA  VRSA  VRE  C. Diff 9/12/2020 6 Antibacterial Agents Terminology Classification of bacteria and antibiotics 9/12/2020 7 Types of bacteria shapes  Bacillus: rod-shaped  Coccus: circular  Chains: Strepto-  Clusters: Staphylo-  Diplo: pairs Broad vs. Narrow Spectrum  Broad spectrum: affects both gram-positive and gram-negative bacteria; active on a large number of organisms  Narrow Spectrum: affects a particular organism; active on a small number of organism **A narrow spectrum is preferred, when possible, to avoid antibiotic resistance and reduce less destruction on the body’s normal flora 9/12/2020 8 Bariostatic vs. Bactericidal  Static: method of action is the inhibition of microbial growth long enough for the body’s own immune system to remove the organisms; these types of antibiotics DO NOT KILL  Inhibition is prevented by:  DNA replication  Metabolism  Protein production  Cidal: method of action is the destruction of microorganisms; these type of antibiotics KILL microorganisms  Prevent bacteria from making a cell wall Antibiotic resistance  Occurs when an antibiotic has lost its effectiveness to kill bacteria growth. Thereby allowing, bacteria to multiply in the presence of therapeutic levels.  Superinfection: a new infection that occurs after an antibiotic is administered killing the normal flora allowing pathogenic organisms to increase due to the absence of competition; hard to treat  Reasons for antibiotic resistance:  Inappropriate use  Patients not taking full prescribed dose  Other reasons?