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Infection Control
Chain of Infection control (organizer)
- Infectious agent or pathogen
- Weird name (bacterium, virus, fungus)
- Reservoir or source of pathogen growth
- Where the agent growths (ex: garapata en lyme disease) 3. Portal of exit
- Mode of transmission (part where the nurse work)
- Here you take precaution to stop the chain
- Standard - Airborne
- Droplet - Contact 5. Portal of entry
- Cuts, eyes, mouth, nose 6. Susceptible host
- (Hombre) Next person sick.
Medical Asepsis or
Clean technique (no sterile)
Surgical Asepsis
(Sterile)
- Hand washing.
- Gloves, PPE
- Hands are rinsed with finger pointing
down.
- Oral medication
- Foley
- Procedure in nose, mouth, vagina, and
rectum
Las manos se pueden limpiar con el hand
sanitizer, except si esta sucias que se usa
agua y javon,
en el caso de C.Diff obligado siempre agua y
javon
- Scrub: Hands are rinsed with finger pointing
upward above elbow.
Principles of surgical Asepsis
- All items used withing a sterile field must
be sterile.
- One inch (2.5cm) Margin around the edge
are not sterile.
- Wet surfaces = (Nonsterile) contaminate
the sterile field.
Board: If sterile field is contaminated with
sterile water = it is not sterile field
- Wound is sterile only from waist to
shoulder.
- Don’t turn your back to the sterile field.
- Open first away fold of the sterile kit, then
laterals and finally the one close to sterile
field (to me).
- Hold Forceps with tips below the handle.
Precautions
Standard precautions = Universal or blood born
∆ All Patients
∆ All body fluids except sweat are infectious
∆ Mucosa and broken skin are infectious.
∆ Practice hand hygiene before and after touching patients
Board: Disseminate herpes Soster = Multiple precautions! All precautions except Droplets
Note: (Only Standards Precaution)
1. HIV
Cryptococcal neoformans infection
Jyrovency Pneumonia carinii Pneumonia
Kaposi’s sarcoma
- Hepatitis
A, B, C, D
A is contact if diarrhea or bowel incontinence
- Mononucleosis infection (beso)
- Anthrax
- Kawasaki = vasculopathy
- Legionary Disease = pneumonias de spores y hot water.
- Histoplasmosis = (cacas de aves) 8. Aspergillosis
- Aspergillosis
- Sarcoidosis
- Osteomelitis (Bone Infection)
- Glomerulonephritis
- Endocarditis
Personal Protective Equipment (PPE)
Wear/Don/Donning Removing
1. Gown: first neck and then
waist
2. Mask
3. Goggle or eye shield
4. Gloves
4. Gloves
3. Goggles
1. Gown
2. mask
1. Mask
N-95 =
- Heppa-filtter
- particulate mask
- special mask
For Pt in airborne precautions for nurse or family member when going inside
the room in negative pressure, before entering in the room.
Remove the mask when are outside the room and the door is close
Lines = transport in a leak proof gab
Body fluid spills: Dilute with bleach solution 10:
1. Infectious Mononucleosis (Kissing disease)
Agent : Epstein bar virus
- Incubation period: 4-6 weeks
- Source: Oral secretion = Saliva
Assessment
- Teenager
- Fatigue = Persistent 1-2 years after
- Sore throat, Fever, malaise, headache, nausea, abdominal pain.
- Lymphadenopathy
- Skin rash
- 15 - 25 years old.
Board: if a teen or young adult has fatigue or sore throat = Infectious mononucleosis.
If an adult has the same symptom = Amygdalates.
Intervention
- Standard precaution
- Hand washing
- Do not share the food or utensils
- Do not kiss
- Check for sign of splenic rupture
- Board like abdomen pain radiates to the left shoulder.
Note: Todas las rupturas de vísceras tienen el mismo síntoma = board like abdomen +
pain to the left shoulder
Rocky mountain spotted fever (standard precaution)
Agent: Rickettsia Rockettsi
- Source: Tick rodents and dogs
- Incubation period = 2-14 days
- Transmision: Bite of infected tick (Dog)
Nota: si la garapata viene del deer (venado)= Lyme disease
Assessment
- Fever, malaise, vomiting, headache, myalgias.
- Maculopapular rash or petechiae in Ankles and wrists more frequent in palms
and soles
Intervention
- Teaching = Same to Lyme disease
- Wear long sleeves shirts, long pants tucked into long socks, pulled up over the
leg part.
Light colors
Wear a hat.
- Following paths (trillos) rather than walking in tall grass and shrub areas.
- Apply insects' repellent before possible exposure to areas where Thicks are
found.
- Keeping yards at home trimmed and free of accumulated grass.
- Apply repellent to dogs.
- Saving the thick for later identification or discarding in toilet.
- Use twister to remove it.
Board: Follow up? = a person who squeezing the thick. (Has to be send it to the lab or
flushing in toilet)
Lyme Disease = Erythema Migrants (standard)
Agent: Borrelia burgdorferi
Transmission: Tick bite = Deer (venado)
Assessment
➢ Erythema Migrants
➢ Bull eye lesion or target lesion.
Stage 1 Stage 2 Stage 3
- Flu like symptoms
- Skin lesion:
Circular expanding rash
with target like or bull’s
eye or ring lesion
- Cardiac problems
- Bell’s palsy (nerve VII) parte
de la cara paralizada
(cardiac + neuro)
- Arthritis
- Chronic fatigue
(Can last for years)
Treatment
- Remove the thick as soon as possible with tweezers (never scraping)
- Flushing in the toilet or sealed in a jar and send it to the hospital.
Note: este es lo contrario del bee Sting que se remove by scrapping.
2. Antibiotic
Tetracycline,
Doxycycline or
Penicillin
ASAP cuando sospeches que es Lyme D. sin tener la confirmation.
- 4 - 6 weeks after, return to the hospital to confirm diagnostic (los mismos test
del SIDA)
∆ ELISA
− Rotavirus
− Enterovirus
− Shigella
− Salmonella
2. RSV
- VRSA (vancomycin resistant staphylococcus)
- MRSA (methicillin resistant staphylococcus)
- Impetigo
- Conjunctivitis
- UTI E. Coli
- Scabies
- Pediculosis
- Herpes Zoster (shingles)
- Herpes Simple
MRSA & VRSA= Wound infection
If Disseminated Herpes Zoster = multiple precautions
➢
Impetigo (contact precaution)
- Bacterial Infection
- Β hemolytic Streptococcus
- Staphylococcus infection
Note: Después de strep throat, scarlet fever or streptococcal impetigo puede desencadenar a
glomerulonephritis or rheumatic fever
Ex: impetico with a new murmur! = Call Dr bc complication with rheumatic fever
If you have impetigo and now have edema around de eyes call Dr bc complication with a
glomerulonephritis)
Assessment
- Occur due to poor hygiene
- The most common site of infection is in the face around the mouth or nose.
- The lesions begin as a vesicle or pustules surrounded by edema and redness.
- The lesion progress to exudative and crusting stages, and vesicular fluid becomes
cloudy leaving Honey Crusted lesion.
- Pruritus
- Burning
- Enlarged lympho-nodes.
Intervention
- Contact Isolation until 24-48 hours after antibiotic = Bactrim Ointment.
- Allow lesion to dry by air exposure
- Assist the child with daily bath and antibacterial soap.
- Apply warn compress (normal saline) 2-3 times per day.
- Followed by a mild soap and water to remove the crust.
- Burrow’s solution may be used (to remove crust)
- Then apply antibiotics. (Bactrim)
- Use emollients to prevent skin cracking
- Separate linens, clothes, dishes, etc.
➢ Pediculosis (contact) (piojos)
- Infestation of the hair and scalp with lice
- Incubation period 7- 10 days
- Lice can survive 48 hours away from the host
- Lice communication- cannot go to the school
- Nits (liendra) no communication, child can go to the school.
Board: Teaching family to save in plastic bag non washable stuff or no using.
Intervention
- Permethrin 1% cream rinse (nix) or shampoo que viene para eso en kit.
- Daily removal of nits with extra- fine tooth metal nit comb. Use gloves.
- Hairbrush or combs should be discard or soak in boiling water for 10 minutes.
- Instruct parents that non-essential bedding, toys, and clothing can be store in a tightly
seal bag for 2 weeks (15 days). Board.
- Furniture and carpets need to be vacuumed
Nota: los perros no cogen piojos.
➢ SCABIES (Contact)
- Parasite skin disorder ( keyword = Burrow lesion)
Assessment
- Pruritic rash, more frequently at night
- Sites more affected
- Axillar
- Ano-genital area
- Wrist
- Hands (webs, between finger)
- Burrow lesion fine grayish red lines
Intervention
- Topical application of permethrin
- Apply after bath or at night and remove in the morning 10-12h after (10-12h).
- Lindane = Apply below the neck
- Contraindicate in children less than 2 years and pregnant woman (bc teratogenic →to
prevent Seizure.
Board: Child with rubella when send him to the school? = 7 days after rash
Assessment
- Low grade fever
- Malaise
- Pinkish red maculopapular rash begins on the face and spreads to entire body
within 1-3 days after.
- Generalize lymphonodes adenopathy (most commonly suboccipital)
- Occipital or suboccipital lymphonodes, (Adenophathy).
Intervention
- Symptomatic = rest and fluids.
- Isolate the infected child from pregnant woman (family, staff)
Board: mom had rubella during pregnant, can the newborn stay with mom, yes! (
days after, no longer communicable.
Pertussis (whooping cough) (droplet)
Agent: Bordetella Pertussis (bacterial)
Incubation Periord: 5 – 21 days
Communicable period: During catarrhal stage
Assessment
Catarrhal Stage Paroxysmal (no communicable) Recovery
Cough
Mild upper respiratory symptoms.
Mild Fever
Conjunctivitis
Cough episodes
Severe burst of cough with inspiration
Whoop.
During this episode, child become
flushed eyes,
Tongue protrusion that relieves when
patient vomits
Back to
normal
Treatment
- Droplet Isolation 24 – 48 hours after antibiotic
- Decreased environmental factors such as: dust, smoke, sudden change in
temperature.
- Suction and humidified O2.
Nota: Todo lo bacterial, 48 hours después del antibiotic deja de ser isolation, except
TB.
Diphtheria (droplet)
Agent: Corynebacterium Diphetria
Incubation period : 2-5 days
Communicable: variable
Keyword: Bull neck, Tracheostomy set at bed side = Priority
Assessment
- Low grade fever
- Malaise
- Sore throat
- Foul smelling mucopurulent nasal discharge.
- Dense pseudo membrane ot the throat
- Lymphadenitis – neck edema = Bull neck
Treatment
- Isolation for 24 – 48 hours after Isolation
- Administer Diphtheria antitoxin
- Bed Rest
- Administer antibiotic
- Tracheostomy at bed side
Scarlet Fever
Keyword = Strawberry tongue
Sandpaper rash
Pasties line
▪ Acute infection disease
▪ Incubation period : 2-7days
▪ Communicable period : variable (+- = 2 weeks after) Cause
- Β nemolytic Streptococo (mismo de amigdalitis e impétigo, strepthroat)
Complications (OJO)
- Glomerulonephritis = Edema around de eyes
- Rheumatic fever= New murmur → Endometritis
- Call the Dr.
Assessment
- Abrupt high fever, vomiting, headache, enlarged, lymphonodes, malaise,
abdominal pain.
- A red fine, sandpaper like rash or sunburn rash (axilas., groin, and neck, then
spread to cover entire boy, except face.
- Rash blanches with pressure except in areas of deep creases and folds = pastias
line.
- Skin desquamation.
- Strawberry tongue.
Treatment
- Droplet precaution 24-48 hours after antibiotic
- Bed rest.
- Encourage fluid intake.
MUMPS (Droplet)
Agent: Paramyxovirus
6 – 12 exchange of air per hour
Door Close
Particulate, fitted Hepa filter mask = N
N-95 mask for nurse or family member inside the room
TB always use N- 95
Pathologies AIRBRONE Precaution
- Measles (rubeola) Koplik’s spots
- Chicken pox (varicella) Smallpox
- TB
- For chicken pox and measles only use N-95 if not immune staff: o No had the
disease before
o Not had the vaccine before
Rubeola Measles (Airborne)
▪ Acute viral disease
▪ Agent: Paramyxovirus
▪ Communicable: 5 days before and 5 days after rash
▪ Keyword: Koplik’s Spots
Assessment
1. 3Cs disease
Coryza
Cough
Conjunctivitis
2. Erythema maculopapular staring on the fa e and spread downward to entire body.
Turning brownish (after)
Lasting 6-7 days
3. Koplik’s spots
Small red spots with bluish one center and a red base on the buccal
mucosa.
Nota: N-95 if no immune staff
If vaccine or history of rubeola, no need for N- 95
Same to chicken POX.
Intervention
- Bed rest
- Cool mist vaporizer (cough & sneezes)
- Dime light if photophobia
4. Antipyretic for fever Never ASA= to prevent Reye Syndrome
Reye syndrome
Nota: La ASA se puede administrar en bacterial infection (eg: Kawaqsaky síndrome)
pero no in viral infection
Chickenpox = Varicela (
airborne)
▪ Agent: Varicella Zoster virus
▪ Incubation: 14 – 21 days
▪ Communicable: 7 days before and 7 days after rash
- Child or adult can return school/work when all lesion are crusted
(dry) Keyword: At the same time occur different stages of types or
healing lesion
Board: picture with only one lesion = Impetigo
Several = Chicken pox
Foto con lesion en antebrazo = Ántrax
Assessment (chickenpox)
- Headache, fever, malaise
- Rash in different stages of healing at the same time
Papulas
Vesiculas
Pustulaes
Crust
- Rash appear on the trunk, scalp, vagina, rectum, genital area - Except
palm of hands and soles. Intervention (SATA)
- Bath with calamine, Cetaphil, oatmeal, baking soda.
- Diphenhydramine for pruritus
- Apply mitten restrain to the child to prevent skin lesion infection 4. Never use
ASA
Nota: one RN solo para ellos (No RN pregnant bc immunocompromise)
Mitten restrain en todo lo que pique para que no se pueda rascar.
Herpes Zoster (singles)
If Herpes Zoster = Contact Precaution
If Disseminated or generalized Herpes Zoster = Multiple precaution =
Airborne – Contact – Standard
Respiratory Insufficiency
- Ebola
▪ Hemorrhagic Fever
▪ Mosquito bite (agent) ▪ Multiple Precaution
Droplet
Contact
Standard
Airborne
Symptoms
- Petechiae
- Fever
- Hemorrhage
- Use condom 3 months after Ebola because transmission = body fluids
Biological Warfare Agente
1. Anthrax (standard)
▪ Cause by bacillus anthraxis
▪ Transmitted by direct contact to the spore (NO person to person)
Assessment (Anthrax)
Inhaled Skin (cutaneous) GI
Inhalation of spores
Flu like symptoms
Fever
Severe respiratory problems
with hemoptysis
Spores enter the skin
through cuts and
abrasion.
Itchy bump like mosquito
bite.
Small liquid filled sac
(ampollas)
Painless ulcer with black
areas = Necrosis
of contaminated
undercooked food.
Nausea, vomiting
Abdominal pain
Diarrhea: GI bleeding
Intervention
- Decontamination period = Nurse use all PPE
Do not agitate clothes
Do not pull over
Cut clothes with scissors
Instruct patient to shower with shampoo, soap and water (el tiempo que
quiera).
- Decontaminated surface with bleach solution.
Treatment
Ciprofloxacin (choice) or Doxycycline
3. Botulism (standard)
▪ Bacterial Infection
▪ Contaminated food
Bulging or depressed canned food used
Ingestion of honey (NO honey in children less than 1 year)
Assessment ( same to Myastemia Gravis)
- Descending paralysis
- Ptosis (drooping eyes)
- Weakened jaw clench
- Disphagia
- 12 - 72 hours after exposure – Severe respiratory disfunction and death.
Intervention
1. Antitoxin botulinic
Board: Cual de las bioterrorism lleva una toxina = Botulismo
2. Heating food (solido or liquid) 212° F at least 10 minutes to inactivated bacterial 3. Antibiotic = Amynoglucoside = Los que terminan en mycin y que no tenga
THRO.
Nota: el botox es igual a un botulism
3. Plaque yersinia Pestis
▪ Transmite through Fleabites (pulgas)
Bubonic Plaque (
- Fever
- Headache
- Lymphonodes
enlarge
stantard)
ment
Septicemic Plaque
Infection
standard) Pneumonic Plaque
(Droplet)
- Cough
- Fever
- Sputum
- Pleuritis (ches pain)
Treatment
- Streptomycin or gentamycin 4. Smallpox = Chicken Pox (Airborne)
Assessment
Cholinergic:
- Lacrimation - Salivation
- ↑ Sweating - Diarrhea
- ↑ Urinary output - loss of consciousness
- Seizure - Floppy paralysis
- Death occur in few minutes to hours
Treatment
Atropine
Pralidoxime.
CDC vaccination program
