Health care-associated infection: Nursing

A healthcare associated infection or H I is when a pathogen is transmitted to a patient who has 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 in the presence of a causative agent or pathogen, which is any disease causing microorganism like viruses, bacteria, yeast fungi or protozoa.

Examples of common pathogens include the bacteria, e coli and the COVID-19 virus. The second link is the reservoir or environment where the pathogen normally lives multiplies and grows 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 is known as clean technique, which 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 healthcare 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 inadequate object with a pathogen which can then infect another host if they encounter that object.

Common objects include doorknobs and medical equipment like BP 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 length 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 known infectious illnesses 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 is 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 H I be sure to notify the health care provider or registered nurse immediately.

All right. As a quick recap a healthcare associated infection or ha I is when a pathogen is transmitted to a patient who has been hospitalized for at least 48 hours.

As the nurse, you can prevent healthcare associated infections by breaking the chain of infection