The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [89]
Sources of infection
An individual may become infected with organisms already present on their body (endogenous infection) or introduced from elsewhere (exogenous infection). The majority of HCAIs are endogenous, hence the importance of procedures such as effective skin decontamination prior to invasive procedures.
Indicators and effects of infection
Generally, infection is said to have occurred when infectious agents enter a normally sterile area of the body and cause symptoms as a result. There are obvious exceptions to this – for example, the digestive tract is not sterile, being home to trillions of micro-organisms, but many types of infectious gastroenteritis are caused by particular organisms entering this area – but it is a useful working definition. The symptoms of infection are listed below. Not all symptoms will be present in all cases, and it should be noted that many symptoms are due to the body’s response to infection and so may not be present in severely immunocompromised patients.
Symptoms of infection
Heat: the site of the infection may feel warm to the touch, and the patient may have a raised temperature.
Pain: at the site of the infection.
Swelling: at the site of the infection.
Redness: at the site of the infection.
Pus.
Feeling of general malaise.
In gastrointestinal infection: abdominal pain and tenderness; nausea; diarrhoea and/or vomiting.
In urinary tract infection: frequency of micturition; often confusion in the elderly; loin pain and/or abdominal discomfort.
Evidence-based approaches
Rationale
The principle of all infection prevention and control is preventing the transmission of infectious agents. However, the measures taken to reduce the risk of transmission must be reasonable, practicable and proportionate to the risk of transmission and the effects of infection with any particular agent. For example, while Staphylococcus aureus can cause severe infections, it is carried by around a third of the population and so isolating every patient carrying it would not be practicable. Meticillin-resistant Staphylococcus aureus (MRSA) can cause equally serious infections, is resistant to many of the antibiotics that would normally be used to treat these infections and is carried by far fewer people, so it is both reasonable and practicable to take additional precautions to prevent its spread in healthcare. These may include isolation in an acute hospital but it would not be reasonable to segregate a colonized individual in a mental health unit where social interaction may form part of their care and the risk to other individuals is less.
The management of any individual who is infected or colonized with an organism that may pose a risk to other individuals must be based on a risk assessment that takes into account how easily the infectious agent can be passed to other people; the susceptibility to infection of other people being cared for in the same area and the likely consequences of their becoming infected; the practicality of implementing particular infection prevention and control precautions within that area or institution (the number of single rooms available, for example); and the individual’s other nursing needs. The infection prevention and control policies of health and social care providers are based on generic risk assessments of their usual client or patient group and should be adhered to unless there are strong reasons to alter procedures for a particular individual’s care. In such circumstances, the advice of the infection prevention and control team (IPCT) should be sought first. Nurses working in independent and social care settings should seek advice from the IPCT of the local