Transcript So Why All the Fuss About Hand Hygiene? pathogens is via hands!
So Why All the Fuss About Hand Hygiene?
Most common mode of transmission of pathogens is via hands!
Infections acquired in health care settings Spread of antimicrobial resistance
Evidence of Relationship Between Hand Hygiene and Health Care Associated Infections
Substantial evidence that hand hygiene reduces the incidence of infections Historical study: Semmelweis More recent studies: rates lower when antiseptic handwashing was performed Guideline for Hand Hygiene in Health-care Settings.
MMWR 2002
; vol. 51, no. RR-16.
Indications for Hand Hygiene
When hands are visibly dirty, contaminated, or soiled, wash with non antimicrobial or antimicrobial soap and water. If hands are not visibly soiled, use an alcohol-based handrub for routinely decontaminating hands.
Guideline for Hand Hygiene in Health-care Settings.
MMWR 2002
; vol. 51, no. RR-16.
Specific Indications for Hand Hygiene
Before: – – – Patient contact Donning gloves when inserting a CVC Inserting urinary catheters, peripheral vascular catheters, or other invasive devices that don’t require surgery After: – – Contact with a patient’s skin Contact with body fluids or excretions, non intact skin, wound dressings – Removing gloves Guideline for Hand Hygiene in Health-care Settings.
MMWR 2002
; vol. 51, no. RR-16.
Recommended Hand Hygiene Technique
Handrubs – Apply to palm of one hand, rub hands together covering all surfaces until dry – Volume: based on manufacturer Handwashing – Wet hands with water, apply soap, rub hands together for at least 15 seconds – Rinse and dry with disposable towel – Use towel to turn off faucet Guideline for Hand Hygiene in Health-care Settings.
MMWR 2002
; vol. 51, no. RR-16.
Fingernails and Artificial Nails
Natural nail tips should be kept short; no longer than the end of the finger tip Artificial nails should not be worn Guideline for Hand Hygiene in Health-care Settings.
MMWR 2002
; vol. 51, no. RR-16.
PREVENTION IS PRIMARY!
Protect patients…protect health care personnel… promote quality health care!
Personal Protective Equipment Definition
“specialized clothing or equipment worn by an employee for protection against infectious materials” (OSHA) PPE Use in Healthcare Settings
Regulations and Recommendations for PPE
OSHA issues workplace health and safety regulations. Regarding PPE, employers must: – Provide appropriate PPE for employees – Ensure that PPE is disposed or reusable PPE is cleaned, laundered, repaired and stored after use OSHA also specifies circumstances for which PPE is indicated CDC recommends when, what and how to use PPE
PPE Use in Healthcare Settings
Types of PPE Used in Healthcare Settings
• • •
Gloves – protect hands Gowns/aprons – protect skin and/or clothing Masks and respirators– protect mouth/nose
–
Respirators – protect respiratory tract from airborne infectious agents
•
Goggles – protect eyes
•
Face shields – protect face, mouth, nose, and eyes PPE Use in Healthcare Settings
Factors Influencing PPE Selection
•
Type of exposure anticipated
–
Splash/spray versus touch
–
Category of isolation precautions
•
Durability and appropriateness for the task
•
Fit PPE Use in Healthcare Settings
Gloves
•
Purpose –
•
patient care
•
environmental services
•
Glove material –
•
Vinyl
• •
Latex Nitrile
•
Sterile or nonsterile PPE Use in Healthcare Settings
Gloves
•
Purpose – patient care, environmental services, other
•
Glove material – vinyl, latex, nitrile, other
• •
Sterile or non-sterile One or two pair
•
Single use or reusable PPE Use in Healthcare Settings
Do’s and Don’ts of Glove Use
Change gloves – During use if torn and when heavily soiled (even during use on the same patient) – After use on each patient Discard in appropriate receptacle – Never wash or reuse disposable gloves
PPE Use in Healthcare Settings
Gowns or Aprons
• •
Purpose of use Material –
–
Natural or man-made
–
Reusable or disposable
–
Resistance to fluid penetration
•
Clean or sterile PPE Use in Healthcare Settings
Face Protection
• •
Masks – protect nose and mouth
–
Should fully cover nose and mouth and prevent fluid penetration Goggles – protect eyes
–
Should fit snuggly over and around eyes
– –
Personal glasses not a substitute for goggles Anti-fog feature improves clarity PPE Use in Healthcare Settings
Face Protection
Face shields – protect face, nose, mouth, and eyes – Should cover forehead, extend below chin and wrap around side of face
PPE Use in Healthcare Settings
Respiratory Protection
•
Purpose – protect from inhalation of infectious aerosols (e.g., Mycobacterium tuberculosis)
•
PPE types for respiratory protection
– –
Particulate respirators Half- or full-face elastomeric respirators
–
Powered air purifying respirators (PAPR) PPE Use in Healthcare Settings
Elements of a Respiratory Protection Program
• • • •
Medical evaluation Fit testing Training Fit checking before use PPE Use in Healthcare Settings
Key Points About PPE
•
Don before contact with the patient, generally before entering the room
•
Use carefully – don’t spread contamination
•
Remove and discard carefully, either at the doorway or immediately outside patient room; remove respirator outside room
•
Immediately perform hand hygiene PPE Use in Healthcare Settings
Sequence* for Donning PPE
• • • •
Gown first Mask or respirator Goggles or face shield Gloves *Combination of PPE will affect sequence – be practical PPE Use in Healthcare Settings
How to Don a Gown
• • • •
Select appropriate type and size Opening is in the back Secure at neck and waist If gown is too small, use two gowns
–
Gown #1 ties in front
–
Gown #2 ties in back PPE Use in Healthcare Settings
How to Don a Mask
• • • •
Place over nose, mouth and chin Fit flexible nose piece over nose bridge Secure on head with ties or elastic Adjust to fit PPE Use in Healthcare Settings
How to Don a Particulate Respirator
•
Select a fit tested respirator
• •
Place over nose, mouth and chin Fit flexible nose piece over nose bridge
• •
Secure on head with elastic Adjust to fit
•
Perform a fit check –
–
Inhale – respirator should collapse
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Exhale – check for leakage around face PPE Use in Healthcare Settings
How to Don Eye and Face Protection
• •
Position goggles over eyes and secure to the head using the ear pieces or headband Position face shield over face and secure on brow with headband Adjust to fit comfortably
How to Don Gloves
• • • •
Don gloves last Select correct type and size Insert hands into gloves Extend gloves over isolation gown cuffs PPE Use in Healthcare Settings
How to Safely Use PPE
• • •
Keep gloved hands away from face Avoid touching or adjusting other PPE Remove gloves if they become torn; perform hand hygiene before donning new gloves
•
Limit surfaces and items touched PPE Use in Healthcare Settings
PPE Use in Healthcare Settings: How to Safely Remove PPE
“Contaminated” and “Clean” Areas of PPE
•
Contaminated – outside front
•
Areas of PPE that have or are likely to have been in contact with body sites, materials, or environmental surfaces where the infectious organism may reside
•
Clean – inside, outside back, ties on head and back
•
Areas of PPE that are not likely to have been in contact with the infectious organism PPE Use in Healthcare Settings
Sequence for Removing PPE
• • • •
Gloves Face shield or goggles Gown Mask or respirator PPE Use in Healthcare Settings
Where to Remove PPE
• •
At doorway, before leaving patient room or in anteroom* Remove respirator outside room, after door has been closed* *Ensure that hand hygiene facilities are available at the point needed, e.g., sink or alcohol-based hand rub PPE Use in Healthcare Settings
How to Remove Gloves (1)
• • •
Grasp outside edge near wrist Peel away from hand, turning glove inside-out Hold in opposite gloved hand PPE Use in Healthcare Settings
How to Remove Gloves (2)
•
Slide ungloved finger under the wrist of the remaining glove
•
Peel off from inside, creating a bag for both gloves
•
Discard PPE Use in Healthcare Settings
Remove Goggles or Face Shield
PPE Use in Healthcare Settings
• • •
Grasp ear or head pieces with ungloved hands Lift away from face Place in designated receptacle for reprocessing or disposal
Removing Isolation Gown
PPE Use in Healthcare Settings
• •
Unfasten ties Peel gown away from neck and shoulder
•
Turn contaminated outside toward the inside
•
Fold or roll into a bundle
•
Discard
Removing a Mask
• • •
Untie the bottom, then top, tie Remove from face Discard PPE Use in Healthcare Settings
Removing a Particulate Respirator
Lift the bottom elastic over your head first Then lift off the top elastic Discard
PPE Use in Healthcare Settings
Hand Hygiene
•
Perform hand hygiene immediately after removing PPE.
–
If hands become visibly contaminated during PPE removal, wash hands before continuing to remove PPE
•
Wash hands with soap and water or use an alcohol-based hand rub *Ensure that hand hygiene facilities are available at the point needed, e.g., sink or alcohol-based hand rub PPE Use in Healthcare Settings
Standard Precautions
•
Assumes blood and body fluid of ANY patient could be infectious
•
Recommends PPE and other infection control practices to prevent transmission in any healthcare setting
•
Decisions about PPE use determined by type of clinical interaction with patient PPE Use in Healthcare Settings
PPE for Standard Precautions (1)
• •
Gloves – Use when touching blood, body fluids, secretions, excretions, contaminated items; for touching mucus membranes and nonintact skin Gowns – Use during procedures and patient care activities when contact of clothing/ exposed skin with blood/body fluids, secretions, or excretions is
PPE for Standard Precautions (2)
•
Mask and goggles or a face shield – Use during patient care activities likely to generate splashes or sprays of blood, body fluids, secretions, or excretions PPE Use in Healthcare Settings
What Type of PPE Would
You
Wear?
• • • •
Giving a bed bath?
Suctioning oral secretions?
Transporting a patient in a wheel chair?
Responding to an emergency where blood is spurting?
PPE Use in Healthcare Settings
• • • •
Drawing blood from a vein?
Cleaning a patient with diarrhea?
Irrigating a wound?
Taking vital signs?
What Type of PPE Would
You
Wear?
•
Giving a bed bath?
•
Generally none
•
Suctioning oral secretions?
•
Gloves and mask/goggles or a face shield – sometimes gown
•
Transporting a patient in a wheel chair?
•
Generally none required
•
Responding to an emergency where blood is spurting?
•
Gloves, fluid-resistant gown, mask/goggles or a face shield PPE Use in Healthcare Settings
• • • •
Drawing blood from a vein?
•
Gloves Cleaning an incontinent patient with diarrhea?
•
Gloves w/wo gown Irrigating a wound?
•
Gloves, gown, mask/goggles or a face shield Taking vital signs?
–
Generally none
PPE for Expanded Precautions
•
Expanded Precautions include
–
Contact Precautions
– –
Droplet Precautions Airborne Infection Isolation PPE Use in Healthcare Settings
Use of PPE for Expanded Precautions
•
Contact Precautions – Gown and gloves for contact with patient or environment of care (e.g., medical equipment, environmental surfaces)
•
In some instances these are required for entering patient’s environment
•
Droplet Precautions – Surgical masks within 3 feet of patient
•
Airborne Infection Isolation – Particulate respirator * *Negative pressure isolation room also required PPE Use in Healthcare Settings
Hand Hygiene
• •
Required for Standard and Expanded Precautions Perform…
– –
Immediately after removing PPE Between patient contacts
•
Wash hands thoroughly with soap and water or use alcohol-based hand rub PPE Use in Healthcare Settings
PPE Use in Healthcare Settings: Final Thoughts
PPE is available to protect you from exposure to infectious agents in the healthcare workplace Know what type of PPE is necessary for the duties you perform and use it correctly
Classes of Microorganisms
Non-pathogenic
– – –
normal do not produce disease beneficial Pathogenic
–
cause infection and disease May be non-pathogenic in one body system, pathogenic in another (E. coli
)
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Classes of Microorganisms
Aerobic
–
requires oxygen to live
Anaerobic
–
does not require oxygen to live 2.02 Understand infection control 49
Classes of Microorganisms
6 classes of microorganisms – Bacteria – Protozoa – Fungi – Rickettsiae – Viruses – Helminths
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Classes of Microorganisms
Bacteria Often considered the causes of disease Certain bacteria – – – produce antibiotics live in the body without problems live on the roots of certain plants, converting nitrogen into a usable form – help break down dead organic matter Classified by shape and arrangement Treated with antibiotics
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Classes of Microorganisms
Bacteria – Cocci • round in shape – – diplococci streptococci – staphylococci
Streptococci 2.02 Understand infection control Staphylococcal clusters 52
Classes of Microorganisms
Bacteria – Bacilli • rod shape – – – single pairs chains • • may have flagella may form spores – difficult to treat
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Classes of Microorganisms
Bacteria – Spirilla • spiral or corkscrew shape –
vibrio - spirochete Cholera 2.02 Understand infection control Treponema pallidum 54
Classes of Microorganisms
Bacteria Some bacteria develop resistance to antibiotics Very difficult to cure – Methicillin-resistant Staphylococcus (MRSA) – Multidrug-resistant Staphylococcus (MDSA)
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Classes of Microorganisms
Protozoa – One celled, animal-like organism – Contain a nucleus and other defined organelles
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Classes of Microorganisms
Fungi – organisms that usually enjoy a symbiotic, but sometimes parasitic relationship with their host – provide numerous drugs and foods – provide bubbles in bread, champagne, and beer – cause a number of plant and animal diseases – fungal diseases are very difficult to treat
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Classes of Microorganisms
Fungi
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Classes of Microorganisms
Rickettsiae – – rod-shaped, parasitic bacteria live in the tissues of ticks, fleas, and lice – transmitted to humans through bites – invade the new host from within
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Classes of Microorganisms
Viruses – small, infectious agent – requires a host for survival – over 5,000 types – can combine in multiple ways to produce a wide range of diseases – produce immune response in humans – treated with antiviral drugs
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Classes of Microorganisms
Helminths – – – – – – Parasitic worm-like organisms Live inside the host Feed off their host Disrupt nutrient absorption Lead to weakness Excrete toxins making host susceptible to other diseases – Approximately 30 billion people globally are infected
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Classes of Microorganisms
Bacteria Protozoa Fungi Rickettsiae Viruses Helminths
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Methods used to control the spread of infection Vaccinations
Administration of a foreign antigen to produce immunity to a disease.
Most effective and least expensive method to prevent disease
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Methods used to control the spread of infection Vaccinations
Injected pathogen may be live, weakened, killed or inactivated Administered to stimulate the immune response
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Methods used to control the spread of infection Vaccinations
May be given after disease exposure or after the disease was contracted Given by injection or orally
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Methods used to control the spread of infection Aseptic Control
Antisepsis
Disinfection
Sterilization 2.02 Understand infection control 66
Methods used to control the spread of infection Aseptic Control
Antisepsis
– effective in preventing or inhibiting the growth of pathogenic organisms, but not spores or viruses – safe to be used on skin
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Methods used to control the spread of infection Aseptic Control
Disinfection
– destroys pathogenic organisms that are already present – not effective against spores or viruses – chemicals are used – not used on skin
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Methods used to control the spread of infection Aseptic Control
Sterilization
– kills all microorganisms, including spores and viruses – methods • • • • steam under pressure gas radiation chemicals – not used on skin
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Methods used to control the spread of infection Aseptic Control
Antisepsis
Disinfection
Sterilization 2.02 Understand infection control 70
Methods used to control the spread of infection
Precautions
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Methods used to control the spread of infection Standard Precautions
Used on ALL patients
Includes:
– Hand washing – Personal Protective Equipment (PPE) • Gloves • • Gowns Masks and eye protection – – – – – – Needle stick safety Sharps Spills and splashes Resuscitation devices Waste and linen disposal Injuries
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Methods used to control the spread of infection Standard Precautions
Hand washing
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Methods used to control the spread of infection Standard Precautions
Personal protection equipment (PPE) 2.02 Understand infection control 74
Methods used to control the spread of infection Standard Precautions
Gloves
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Methods used to control the spread of infection Standard Precautions
Gowns
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Methods used to control the spread of infection Standard Precautions
Masks and eye protection
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Methods used to control the spread of infection Standard Precautions
Needlestick safety 2.02 Understand infection control 78
Methods used to control the spread of infection Standard Precautions
Sharps
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Methods used to control the spread of infection Standard Precautions
Spills and splashes
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Methods used to control the spread of infection Standard Precautions
Resuscitation devices
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Methods used to control the spread of infection Standard Precautions
Waste and linen disposal
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Methods used to control the spread of infection Standard Precautions
Injuries
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Methods used to control the spread of infection Standard Precautions
Used on ALL patients
Includes:
– Hand washing – Personal Protective Equipment (PPE) • Gloves • • Gowns Masks and eye protection – – – – – – Needle stick safety Sharps Spills and splashes Resuscitation devices Waste and linen disposal Injuries
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Methods used to control the spread of infection Bloodborne Pathogen Standard
Applies to all occupational exposure of blood or other potentially infectious material.
Blood = human blood, blood components, blood products Bloodborne pathogens = disease causing organisms in blood (Hep. B, Hep. C, HIV)
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Methods used to control the spread of infection Bloodborne Pathogen Standard In an emergency when you cannot identify body fluids or tell whether they contain blood, treat all body fluids as potentially infectious.
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Methods used to control the spread of infection Tuberculosis Standard
OSHA Standard to reduce occupationally transmitted/acquired TB Requires FIT tested and training in the use of specific respiratory PPE PPD skin test annually
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Methods used to control the spread of infection Extended Infection Control Precautions Standard Precautions PLUS
Airborne Precautions Contact Precautions Droplet Precautions
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Methods used to control the spread of infection Extended Infection Control Precautions
Transmission based precautions
– Additional precautions used with patients infected with pathogens that are spread via: • • • airborne transmission droplet transmission direct contact – Requires isolation
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Methods used to control the spread of infection Extended Infection Control Precautions
Airborne precautions
– Patient pathogens are transmitted by airborne droplets – Specific PPEs • fitted mask
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Methods used to control the spread of infection Extended Infection Control Precautions
Contact precautions
– Patient pathogens are able to be spread by direct or indirect contact – Specific PPEs • • gloves gowns
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Methods used to control the spread of infection Extended Infection Control Precautions
Droplet precautions
– Used when large-particle droplets are expelled during coughing, sneezing, talking or laughing – Specific PPEs • mask if working within 3 feet of patient
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Methods used to control the spread of infection Extended Infection Control Precautions
Protective or reverse precautions 2.02 Understand infection control 93
Methods used to control the spread of infection Extended Infection Control Precautions Standard Precautions PLUS
Airborne Precautions Contact Precautions Droplet Precautions
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Transmitting Infection
Direct contact Indirect contact Airborne Vector-borne
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Transmitting Infection
Direct contact
Person to person Animal to person Mother to unborn child
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Transmitting Infection
Indirect contact
Pathogens are passed along on inanimate objects
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Transmitting Infection
Airborne
Pathogens are carried through the air Cling to surroundings and are spread
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Transmitting Infection
Vector-borne
Insects carry pathogen from host to host
Flea Tick 2.02 Understand infection control Mosquito 99
Transmitting Infection
How you get an infection… – Causative agent – Reservoir – Portal of exit – Mode of transmission – Portal of entry – Susceptible host…breaking the chain!
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Chain of Infection
Causative agent Source or reservoir Susceptible host Portal of entry Portal of exit Mode of transmission 2.02 Understand 101 infection control
Chain of Infection
Causative agent
– pathogen
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Chain of Infection
Reservoir
– area where the pathogen can live
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Chain of Infection
Portal of exit
– way for the pathogen to escape from the reservoir
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Chain of Infection
Mode of transmission
– way for pathogen to be transmitted
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Chain of Infection
Portal of entry
– way to enter new reservoir
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Chain of Infection
Susceptible host
– able to be affected – person likely to get sick
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Chain of Infection
Causative agent Source or reservoir Susceptible host Portal of entry Portal of exit Mode of transmission 2.02 Understand 108 infection control
Types of Infections
2.02 Understand infection control procedures
Types of Infections
Infection
invasion of the body by microorganisms invading microorganisms: – use the host’s resources to multiply – interfere with normal function – 3 rd leading cause of death in the U. S.
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Types of Infections
Local infection
only a specific portion of the body is infected – pain – redness – heat at the site – swelling – pus – foul smelling drainage
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Types of Infections
Systemic infection
affects the entire body – fever – aches – chills – nausea – vomiting – weakness
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Types of Infections
Endogenous
(endo- inside; genous- type or kind) –
type or kind of infection or disease that originates from within the body
Exogenous
(exo- outside; genous type or kind) –
type or kind of infection or disease that originates outside the body 113
Types of Infections
Nosocomial infections
– –
Hospital acquired infection Transmitted by the health care worker
Opportunistic infections
–
Infections that occur when the body’s defenses are weakened 2.02 Understand infection control 114