1. an infectious agent
2. a reservoir where the infectious agent grows
3. an exit portal of the infectious agent
4. a meas of transmission (e.g., droplet, contact, touching contaminated items)
5. entry portal to a susceptible host (same as exit)
6. a host that must be susceptible to the infectious agent

Nosocomial infections

• an infection that is acquired while the client is in the HC system
• nosocomial infection can come from exogenous source (outside the pt) or endogenous (altered normal flora)
• best way to prevent is through frequent hand washing!!
• most common site: urinary tract; most common causative agents: E. coli and S. aureus

• fever
• increase pulse and resp rate (response to high fever)
• malaise
• anorexia, nausea, and/or vomiting
• enlarged lymph nodes (repository for "waste")

• redness (from dilation of arterioles bringing blood to the area)
• edema
• pain or tenderness
• presence of exudates (dead phagocytes and tissue cells that leak from the vessels)
• warmth of are on palpation
• loss of use of affected part

• Laukocytosis (WBC's over 11,000 uL)
• increases in specific types of WBCs on differential (left shift=an increase in neutrophils)
• elevated erythrocyte sedimentation rate (ESR)
• presence of micro-organism on culture of specific fluid/ area

impaired tissue integrity

risk for infection

risk for social isolation

risk for impaired tissue integrity

Nursing Interventions 

(general guidelines)

• frequent and effective handwashing (most important!!)
• required and recommended immunizations
• good oral hygiene
• adequate amount of fluids
• pulmonary hygiene (turning, coughing or deep breathing; make sure it is done every 2 hours in immobile clients or as ordered by physician)
• aseptic technique and proper PPE

Gloves

(standard precautions)

Masks, eye protection, or face shields

(standard precautions)

• require when care may cause splashing or spraying of body fluids
• mask is necessary to prevent the spread of infection from airborne exposures

Airborne precautions

droplet precautions

contact precautions 

• to protect against droplet infections smaller then 5um (measles, varicella, TB)
• require: a private room, mask/ respiratory protection device for caregivers and visitors, negative pressure airflow exchange in the room of at least 6 exchanges per hour

• protect against droplets larger than 5um (streptococcal pharyngitis or pneumonia, scarlet fever, rubella, pertussis, mumps, mycoplasm pheumonia, meningococcal pneumonia/ sepsis or pneumonic plague)
• Require: private room or w/ other w/ same disease, mask for providers and visitors

• protect the visitors and caregivers against direct client/ environmental contact infections (e.g., respiratory syncytial virus, shigella, enteric diseases caused by micro-organisma, wound infections, herpes simplex, scabies, varicella zoster and multidrug-resistant organisms)
• Require: private room or w/ client w/ same infection, gloves and gowns, disposal of infectious dressing material into a single, nonporous bag w/o touching the outside of the bag

• planning and evaluating of control and prevention plans
• determining public health policies
• ensuring proper medical treatment is available
• monitoring for common-source outbreaks