Health Care-Acquired or Associated Infection
A health care-associated infection, or HAI, is when a pathogen is transmitted to a patient who’s been hospitalized for at least 48 hours.As the nurse, you can prevent health care-associated infections by breaking the chain of infection.The process of transmitting infection is known as the chain of infection and occurs in six continuous links: the causative agent, reservoir, portal of exit, mode of transfer, portal of entry and susceptible host.The first link is the presence of a causative agent, or pathogen, which is any disease-causing microorganism, like viruses, bacteria, yeast, fungi, or protozoa.
Reservoirs can be living, like humans, animals, or insects; waste products, like stool; food; water; or wounds. Common reservoirs in health care settings are unwashed hands, soiled linens, or medical equipment, like stethoscopes.Now, as the nurse you can reduce pathogens and reservoirs through asepsis, which is when pathogens are removed from the environment.
There are two types of asepsis: medical asepsis and surgical asepsis. Medical asepsis, also known as clean technique, is when the number of pathogens or the risk of transmitting the pathogen, is reduced.
This can be done through hand washing, wiping down equipment with a disinfectant, and preoperative skin cleansing. On the other hand, surgical asepsis, also known as sterile technique, is when equipment is sterilized eliminating all pathogens by using high heat or chemicals like when using surgical equipment that has been sterilized in an autoclave.Then, there’s the third link, portal of exit, where the pathogen leaves the reservoir.
Common portals of exit in health care settings include the GI tract, where pathogens exit via feces or emesis; and the respiratory tract, where pathogens leave via aerosolized droplets.You’ll use standard and transmission-based precautions to prevent pathogens from reaching a portal of exit.
Standard precautions are broad protocols used to prevent infection in both the patient and nurse. Standard precautions are used with every patient, regardless of the presence of infection, and involve hand hygiene; use of personal protective equipment, or PPE, like gloves; and covering the mouth while coughing or sneezing.On the other hand, transmission-based precautions are used alongside standard precautions; include contact, droplet, and airborne precautions; and are based on a known pathogen’s mode of transfer, which is the fourth link in the chain.
Mode of transfer is the way in which a pathogen is transported from the reservoir to another host or the external environment.Modes of transfer include direct contact, indirect contact, vector, and droplet.
Direct contact involves physical contact with a host’s contaminated bodily fluids, like urine or blood. Indirect contact is when an infected host contaminates an inanimate object with a pathogen, which can then infect another host if they encounter that object.
Common objects include doorknobs and medical equipment like blood pressure cuffs. Then, there’s vectors, which are any living entity that transfers an infection between humans or from animals to humans.
When a host is bitten or stung by a vector, the pathogen is transmitted to the host. Common vectors include mosquitoes and ticks.
Lastly, there’s droplet which occurs when the pathogen is spread through the air on respiratory droplets, like when an infected host coughs and another host inhales the infected droplets.When caring for your patient with a known infection, be sure to implement appropriate transmission-based precautions.
For example, when caring for your patient with Clostridium difficile, also known as C. diff, a bacterium that transmits through direct and indirect contact, you’ll implement contact precaution.But for your patient with influenza, a virus transmitted through respiratory droplets, you’ll initiate droplet precautions.The fifth link is the portal of entry, where the pathogen enters the host.
Pathogens can enter through mucous membranes found in the eyes, nose, throat, or GI tract; or through compromised skin, such as through an open wound or an indwelling medical device, like an intravenous line.To minimize portals of entry in your patient, ensure personal hygiene, like encouraging them to brush their teeth routinely; and reinforce proper preparation of their food and water, like ensuring their meat is fully cooked before eating.
Also, reinforce they should avoid individuals with a known infectious illness and use PPE, as needed. Be sure to prevent unnecessary breaks in their skin, like excessive needle sticks; and ensure sterile technique is followed during certain procedures, like tracheostomy care or insertion of a urinary catheter.Now, the last link in the chain in the susceptible host, or the individual who’s infected with the pathogen.
Some populations are more susceptible to infections due to their age, like infants or older adults; and their health status, like patients who are immunocompromised or have a chronic disease.
Additionally, patients with indwelling medical devices, like urinary catheters or IV lines, are also susceptible because pathogens can bypass the body’s natural defenses.Be aware of your patient’s risk factors that make them susceptible to infections and monitor them for signs and symptoms of infection, like new onset fever or leukocytosis, which is an increased white blood cell count that can indicate a bacterial infection.
If you suspect an HAI, be sure to notify the health care provider or registered nurse immediately.Alright, as a quick recap...A health care-associated infection, or HAI, is when a pathogen is transmitted to a patient who’s been hospitalized for at least 48 hours.
As the nurse, you can prevent health care-associated infections by
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