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Infection

INFECTION

CONCEPT

Humans may hold dominance over most other life-forms on Earth, but a few varieties of organism have long held mastery over us. Ironically, these life-forms, including bacteria and viruses, are so small that they cannot be seen, and this, in fact, has contributed to their disproportionate influence in human history. For thousands of years, people attributed infection to spiritual causes or, at the very least, to imbalances of "humors," or fluids, in the human body. Today germ theory and antisepsisthe ideas that microbes cause infection and that a clean body and environment can prevent infectionsare ingrained so deeply that we almost take them for granted. Yet these concepts are very recent in origin, and for a much longer span of human history people quite literally wallowed in filthwith predictable consequences.

HOW IT WORKS

What Is Infection?

The term infection refers to a state in which parasitic organisms attach themselves to the body, or to the inside of the body, of another organism, causing contamination and disease in the host organism. Parasite refers generally to any organism that lives at the expense of another organism, on which it depends for support. Numerous parasites and the diseases they cause are discussed in the essay Parasites and Parasitology; in the present context, we are concerned primarily with infections that relate to bacteria and viruses.

Almost all infections contracted by humans are passed along by other humans or animals.

Infections fall into two general categories: exogenous, or those that originate outside the body, and endogenous, which occur when the body's resistance is lowered. Examples of exogenous infection include catching a cold by drinking after someone else from the same glass; coming down with salmonella after ingesting under-cooked eggs, meat, or poultry; getting rabies from a dog bite; or contracting syphilis, AIDS (acquired immunodeficiency syndrome), or some other sexually transmitted disease from an infected partner.

Any number of factorslack of sleep, prolonged exposure to extreme cold or moisture, and so oncan lower the body's resistance, opening the way for an endogenous infection. Malnutrition, illness, and trauma also can be factors in endogenous infection. Substance abuse, whether it be the use of tobacco in its many forms, excessive drinking, or drug use, lowers the body's resistance. Furthermore, all of these behaviors tend to be coupled with poor eating habits, which invite infection by denying the body the nutrients it needs.

Some Terms

A whole array of terminology attends the study of infection and infectious diseases, a subject that is touched upon in the present context but explored at length in its own essay as well. Among these terms are the names for the different branches of study relating to infection, its agents, and the resulting diseases. Although germ theory is a term (defined later) that is used widely in the context of infection, germ itselfa common word in everyday lifeis not used as much as microorganism or pathogen. The latter word refers to disease-carrying parasites, which are usually microorganisms. Two of the principal types of pathogen, bacteria and viruses, are discussed later in this essay.

Words relating to the effects of infectious agents include epidemic, an adjective meaning "affecting or potentially affecting a large proportion of a population"; as a noun, the word refers to an epidemic disease. Pandemic also doubles as an adjective, meaning "affecting an extremely high proportion of a population over a wide geographic area," and a noun, referring to a disease of pandemic proportions. Areas of study relating to pathogens, their effects, and the prevention of those effects include the following.

  • Bacteriology: An area of the biological sciences concerned with bacteria, including their importance in medicine, industry, and agriculture)
  • Epidemiology: An area of the medical sciences devoted to the study of disease, including its incidence, distribution, and control within a population)
  • Etiology: A branch of medical study concerned with the causes and origins of disease. Also, a general term referring to all the causes of a particular disease or condition)
  • Immunology: The study of the immune system, immunity, and immune responses)
  • Pathology: The study of the essential nature of diseases)
  • Virology: The study of viruses

In addition, there are several terms relating to the prevention of infection.

  • Antibiotic: A substance produced by, or derived from, a microorganism, which in diluted form is capable of killing or at least inhibiting the action of another microorganism. Antibiotics typically are not effective against viruses.
  • Antisepsis: The practice of inhibiting the growth and multiplication of microorganisms)
  • Germ theory: A theory in medicine, widely accepted today, that infections, contagious diseases, and other conditions are caused by the actions of microorganisms)
  • Immunity: A condition of being able to resist a particular disease, particularly through means that prevent the growth and development of pathogens or counteract their effects
  • Inoculation: The prevention of a disease by the introduction to the body, in small quantities, of the virus or other microorganism that causes the disease
  • Vaccine: A preparation containing microorganisms, usually either weakened or dead, which are administered as a means of increasing immunity to the disease caused by those microorganisms

Some of these words appear in this essay and others in related essays on infectious diseases and immunity.

Bacteria

Five major groups of microorganisms are responsible for the majority of infections. They include protozoa and helminths, or wormsboth of which are considered in Parasites and Parasitologyas well as bacteria and viruses. Bacteria and viruses often are discussed, along with fungi (the fifth major group), in the context of infection and infectious diseases. In the present context, however, we limit our inquiry to viruses and bacteria.

Bacteria are very small organisms, typically consisting of one cell. They are prokaryotes, a term referring to a type of cell that has no nucleus. In eukaryotic cells, such as those of plants and animals, the nucleus controls the cell's functions and contains its genes. Genes carry deoxyribonucleic acid (DNA), which determines the characteristics that are passed on from one generation to the next. The genetic material of bacteria is contained instead within a single, circular chain of DNA.

Members of kingdom Monera, which also includes blue-green algae (see Taxonomy), bacteria generally are classified into three groups based on their shape: spherical (coccus), rodlike (bacillus), or spiralor corkscrew-shaped (spirochete). Some bacteria also have a shape like that of a comma and are known as vibrio. Spirochetes, which are linked to such diseases as syphilis, sometimes are considered a separate type of creature; hence, Monera occasionally is defined as consisting of blue-green algae, bacteria, and spirochetes.

The cytoplasm (material in the cell interior) of all bacteria is enclosed within a cell membrane that itself is surrounded by a rigid cell wall. Bacteria produce a thick, jellylike material on the surface of the cell wall, and when that material forms a distinct outer layer, it is known as a capsule. Many rod, spiral, and comma-shaped bacteria have whiplike limbs, known as flagella, attached to the outside of their cells. They use these flagella for movement by waving them back and forth. Other bacteria move simply by wiggling the whole cell back and forth, whereas still others are unable to move at all.

Bacteria most commonly reproduce by fission, the process by which a single cell divides to produce two new cells. The process of fission may take anywhere from 15 minutes to 16 hours, depending on the type of bacterium. Several factors influence the rate at which bacterial growth occurs, the most important being moisture, temperature, and pH, or the relative acidity or alkalinity of the substance in which they are placed.

Bacterial preferences in all of these areas vary: for example, there are bacteria that live in hydrothermal vents, or cracks in the ocean floor, where the temperature is about 660°F (350°C), and some species survive at a pH more severe than that of battery acid. Most bacteria, however, favor temperatures close to that of the human body98.6°F (37°C)and pH levels only slightly more or less acidic than water. Since they are composed primarily of water, they thrive in a moist environment.

Viruses

One of the interesting things about bacteria is their simplicity, coupled with the extraordinary complexity of their interactions with other organisms. As simple as bacteria are, however, viruses are vastly more simple. Furthermore, the diseases they can cause in other organisms are at least as complex as those of bacteria, and usually much more difficult to defeat. Whereas there are "good" bacteria, as we shall see, scientists have yet to discover a virus whose impact on the world of living things is beneficial. There is something downright creepy about viruses, which are not exactly classifiable as living things; in fact, a virus is really nothing more than a core of either DNA or RNA (ribonucleic acid), surrounded by a shell of protein.

Two facts separate viruses from the world of the truly living. First, unlike all living things (even bacteria), viruses are not composed of even a single cell, and, second, a virus has no life if it cannot infect a host cell. When we say "no life" in this context, we truly mean no life. Although parasites, including bacteria and those species discussed in Parasites and Parasitology, depend on other organisms to serve as hosts, they can live when they are between hosts. They are rather like a person between jobs: without other means of support, the person eventually will go broke or starve, but typically such a person can hang on for a few months until he or she finds a new job. A virus without a host, on the other hand, is simply not alivenot dead, like a formerly living thing, but more like a machine that has been switched off.

Once a virus enters the body of a host, it switches on, and the result is truly terrifying. In order to produce new copies of itself, a virus must use the host cell's reproductive "machinery"that is, the DNA. The newly made viruses then leave the host cell, sometimes killing it in the process, and proceed to infect other cells within the organism. As for the organisms that viruses target, their potential victims include the whole world of living things: plants, animals, and bacteria. Viruses that affect bacteria are called bacteriophages, or simply phages. Phages are of special importance, because they have been studied much more thoroughly than most viruses; in fact, much of what virologists now know about viruses is based on the study of phages.

REAL-LIFE APPLICATIONS

Bacteria and Humans

Not all bacteria are harmful; in fact, some even are involved in the production of foods consumed by humans. For example, bacteria that cause milk to become sour are used in making cottage cheese, buttermilk, and yogurt. Vinegar and sauerkraut also are produced by the action of bacteria on ethyl alcohol and cabbage, respectively. Other bacteria, most notably Escherichia coli (E. coli ) in the human intestines, make it possible for animals to digest foods and even form vitamins in the course of their work. (See Digestion for more on these subjects.) Others function as decomposers (see Food Webs), aiding in the chemical breakdown of organic materials, while still others help keep the world a cleaner place by consuming waste materials, such as feces.

Despite its helpful role in the body, certain strains of E. coli are dangerous pathogens that can cause diarrhea, bloody stools, and severe abdominal cramping and pain. The affliction is rarely fatal, though in late 1992 and 1993 four people died during the course of an E. coli outbreak in Washington, Idaho, California, and Nevada. More often the outcome is severe illness that may bring on other conditions; for example, two teenagers among a group of 11 who became sick while attending a Texas cheerleading camp had to receive emergency appendectomies. The pathogen is usually transmitted through under-cooked foods, and sometimes through other means; for example, a small outbreak in the Atlanta area in the late 1990s occurred in a recreational water park.

BACTERIAL INFECTIONS.

Many bacteria attack the skin, eyes, ears, and various systems in the body, including the nervous, cardiovascular, respiratory, digestive, and genitourinary (i.e., reproductive and urinary) systems. The skin is the body's first line of defense against infection by bacteria and other microorganisms, although it supports enormous numbers of bacteria itself. Bacteria play a major role in a skin condition that is the bane of many a young man's (and, less frequently, a young woman's) existence: acne. Pimples or "zits," known scientifically as Acne vulgaris, constitute one of about 50 varieties of acne, or skin inflammation, which are caused by a combination of heredity, hormones, and bacteriaparticularly a species known as Propionibacterium acnes. When a hair follicle becomes plugged by sebum, a fatty substance secreted by the sebaceous, or oil, glands, this forms what we know as a blackhead; a pimple, on the other hand, results when a bacterial infection, brought about by P. acnes, inflames the blackhead and turns it red. For this reason, antibiotics may sometimes cure acne or at least alleviate the worst symptoms.

Acne may seem like a life-and-death issue to a teenager, but it goes away eventually. On the other hand, toxic shock syndrome (TSS), caused by other bacteria at the surface of the skinspecies of Staphylococcus and Streptococcus can be extremely dangerous. The early stages of TSS are characterized by flulike symptoms, such as sudden fever, fatigue, diarrhea, and dizziness, but in a matter of a few hours or days the blood pressure drops dangerously, and a sunburn-like rash forms on the body. Circulatory problems arise as a result of low blood pressure, and some extremities, such as the fingers and toes, are deprived of blood as the body tries to shunt blood to vital organs. If the syndrome is severe enough, gangrene may develop in the fingers and toes.

In 1980, several women in the United States died from TSS, and several others were diagnosed with the condition. As researchers discovered, all of them had been menstruating and using high-absorbency tampons. It appears that such tampons provide an environment in which TSS-causing bacteria can grow, and this led to recommendations that women use lower-absorbency tampons if possible, and change them every two to four hours. Since these guidelines were instituted, the incidence of toxic shock has dropped significantly, to between 1 and 17 cases per 100,000 menstruating women.

Many bacteria produce toxins, poisonous substances that have effects in specific areas of the body. An example is Clostridium tetani, responsible for the disease known as tetanus, in which one's muscles become paralyzed. A related bacterium, C. botulinum, releases a toxin that causes the most severe form of food poisoning, botulism. Salmonella poisoning comes from another genus, Salmonella, which includes S. typhi, the cause of typhoid fever.

Viral Infections

With viruses, as we have noted, there is no need even to discuss "good" kinds, because there is no such thingall viruses are harmful, and most are killers. The particular strains of virus that attack animals have introduced the world to a variety of ailments, ranging from the common cold to AIDS and some types of cancer. Other diseases related to viral infections are hepatitis, chicken pox, smallpox, polio, measles, and rabies.

One reason why physicians and scientists have never found a cure for the common cold is that it can be caused by any one of about 200 viruses, including rhinoviruses, adenoviruses, influenza viruses, parainfluenza viruses, syncytial viruses, echoviruses, and coxsackie viruses. Each has its own characteristics, its favored method of transmission, and its own developmental period. These viruses can be transmitted from one person to another by sneezing on the person, shaking hands, or handling an object previously touched by the infected person. Surprisingly, some more direct forms of contact with an infected person, as in kissing, seldom spread viruses.

A group of viruses called the orthomyxoviruses transmit influenza, an illness usually characterized by fever, muscle aches, fatigue, and upper respiratory obstruction and inflammation. The most common complication of influenza is pneumonia, a disease of the lungs that may be viral or bacterial. The viral form of pneumonia that goes hand in hand with influenza can be very severe, with a high mortality (death) rate; by contrast, bacterial pneumonia, which typically appears five to ten days after the onset of flu, can be treated with antibiotics.

THE EVER ELUSIVE VIRUS.

Viruses are tricky. Because their generations are very short and their structures extremely simple, they are constantly mutating (altering their DNA and hence their heritable traits) and thus becoming less susceptible to vaccines. This is the reason why flu vaccine has to be prepared a new each year to target the current strains, and even then the vaccine is far less than universally effective. On the other hand, vaccination has a high rate of success for strains of virus that undergo little mutationfor example, the smallpox virus.

One particularly elusive type of virus is known as a retrovirus, which reverses the normal process by which living organisms produce proteins. Ordinarily, DNA in the cell's nucleus carries directions for the production of new protein. Coded messages in the DNA molecules are copied into RNA molecules, which direct the manufacture of new protein. In retroviruses, that process is reversed, with viral RNA used to make new viral DNA, which then is incorporated into host cell DNA, where it is used to direct the manufacture of new viral protein. Among the diseases caused by retroviruses is AIDS, discussed in Infectious Diseases and The Immune System.

Fighting the Invisible War

Every day of our lives, we are at war with microorganisms, both individually and as a species. It is a war that has lasted for several million years, with billions of lives in the balance, yet it is an invisible war. Up until a few centuries ago, in fact, we had no idea what we were fighting. Before the advent of germ theory, the most scientific theories of disease blamed them either on an imbalance of "humors" (blood, phlegm, yellow bile, and green bile), or on inhaling bad air. These were the most advanced ideas, the ones held by men of learning; most of the populace, by contrast, believed that disease was caused by evil spirits, cast upon individuals or populations by an angry God as punishment for disobedience.

Personal hygiene and public health were completely foreign concepts: not only did people bathe infrequently, but they also thought nothing of throwing trashincluding rotting food and even human excrementinto the city streets. This image of trash in the streets may call to mind a city of medieval Western Europe, a place and time widely known for its filth, squalor, and ignorance. Yet such an image also describes Athens during the fifth century b.c., when human imagination, wisdom, and appreciation for beauty reached perhaps their highest points in all of history. In the Athens of Socrates, Herodotus, Hippocrates, and Sophocles, the streets were piled with trash and crawling with vermin. In fact, this lack of concern for cleanliness contributed directly to the end of the Greek golden age, sometimes known as the Age of Pericles, after Athens's great leader (495-425 b.c.)who died in a great plague that swept the germ-ridden city.

BACTERIOLOGY AND ANTI-SEPSIS.

The first inkling of any etiology other than that of imbalanced humors and demons was the work of the Italian physician Girolamo Fracastoro (ca. 1483-1553), who put forth the theory that disease is caused by particles so small they are almost imperceptible. The invention of the microscope in 1590 made it possible to glimpse those particles, which Holland's Anton van Leeuwenhoek (1632-1723)the first human being to observe bacteria and other microorganismsdubbed animalcules, or "tiny animals." The German scholar Athanasius Kircher (1601-1680) also observed "tiny worms" in the blood and pus of plague victims and theorized that they were the source of the infection. This was the first theory that dealt with microbial agents as infectious organisms.

In 1848 Ignaz P. Semmelweis (1818-1865), a Hungarian physician working in German hospitals, came up with a novel idea: after examining the bodies of women who had died of puerperal (childbed) fever, he suggested that doctors should wash their hands in a solution of chlorinated lime water before touching a pregnant patient. Semmelweis's idea resulted in a drastic reduction of puerperal fever cases, but his colleagues denounced his outlandish notion as a useless and foolish waste of time. Six years later, in 1854, modern epidemiology was born when the English physician John Snow (1813-1858) determined that the source of a cholera epidemic in London could be traced to the contaminated water of the Broad Street pump. After he ordered the pump closed, the epidemic ebbedand still many physicians refused to believe that invisible organisms could spread disease.

GERM THEORY.

A major turning point came just three years later, in 1857, when the great French chemist and microbiologist Louis Pasteur (1822-1895) discovered that heating beer and wine to a certain temperature killed bacteria that caused these liquids to spoil or turn into vinegar. Thus was born the process of pasteurization, still used today to purify such foods as milk, because, as Pasteur observed, "There are similarities between the diseases of animals or man and the diseases of beer and wine." Pasteur also dealt the final blow to spontaneous generation, a centuries-old belief that living organisms could originate from nonliving matter. As he showed in 1861, microorganisms present in the air can contaminate solutions that seem sterile.

Then, in 1876, the German physician Robert Koch (1843-1910) proved what Kircher had postulated two centuries earlier: that bacteria can cause diseases. Koch showed that the bacterium Bacillus anthracis was the source of anthrax in cattle and sheep and generalized the methodology he had used in that situation to form a specific set of guidelines for determining the cause of infectious diseases. Known as Koch's postulates, these guidelines define a truly infectious agent as one that can be isolated from an infected animal, cultured in a laboratory setting, introduced into a healthy animal to produce the same infection as in the first animal, and isolated again from the second animal. These ideas formed the basis of research into bacterial diseases and are still dominant in the sciences devoted to the study of disease.

Koch's postulates helped usher in what has been called the golden era of medical bacteriology. Between 1879 and 1889 German microbiologists isolated the organisms that cause cholera, typhoid fever, diphtheria, pneumonia, tetanus, meningitis, and gonorrhea as well the Staphylococcus and Streptococcus organisms. Even as Koch's work was influencing the development of the germ theory, the influence of the English physician Joseph Lister (1827-1912) was being felt in operating rooms. Building on the work of both Semmelweis and Pasteur, Listerfor whom the well-known antiseptic mouthwash Listerine was namedbegan soaking surgical dressings in carbolic acid, or phenol, to prevent postoperative infection.

ANTIBIOTICS.

Whereas antisepsis was the great battleground of the invisible war during the nineteenth century, in the twentieth century the most important struggle concerned the development of antibiotics. The first effective medications to fight bacterial infection in humans were sulfa drugs, developed in the 1930s. They work by blocking the growth and multiplication of bacteria and were initially effective against a broad range of bacteria, but many strains of bacteria have evolved resistance to them. Today, sulfa drugs are used most commonly in the treatment of urinary tract infections and for preventing infection of burn wounds.

The importance of sulfa drugs was eclipsed by that of penicillin, first discovered in 1928 by the British bacteriologist Alexander Fleming (1881-1955). Working in his laboratory, Fleming noticed that a mold that had fallen accidentally into a bacterial culture killed the bacteria. Having identified the mold as the fungus Penicillium notatum, Fleming made a juice with it that he called penicillin. He administered it to laboratory mice and discovered that it killed bacteria in the mice without harming healthy body cells.

It would be more than a decade before the development of a form of penicillin that could be synthesized easily. This drug arrived on the scene in 1941just in time for the years of heaviest fighting in World War IIand after the war pharmaceutical companies began to manufacture numerous varieties of antibiotic. By the last decade of the twentieth century, however, a new problem emerged: bacteria were becoming resistant to antibiotics. This has been the case with medications used to treat conditions ranging from children's ear infections to tuberculosis.

An example is amoxicillin, a penicillin derivative developed in the late twentieth century. Many pediatricians found it a better treatment than penicillin for ear infections, because it did not tend to cause allergic reactions sometimes associated with the other antibiotic. However, by the late 1990s evidence surfaced indicating that certain types of bacteria had developed a protein that rendered amoxicillin ineffective against ear infections. Critics of amoxicillin (or of antibiotic treatments in general) maintained that widespread prescription of the antibiotic actually helped create that situation, because the bacteria developed the protein mutation defensively. Because of these and similar concerns associated with antibiotics, doctors have begun taking measures toward controlling the spread of antibiotic-resistant diseases, for instance by prescribing antibiotics only when absolutely necessary. Research into newer types and combinations of drugs is ongoing, as is research regarding the development of vaccines to prevent bacterial infections.

WHERE TO LEARN MORE

Biddle, Wayne. A Field Guide to Germs. New York: Henry Holt, 1995.

The Big Picture Book of Viruses. Tulane University (Web site). <http://www.tulane.edu/~dmsander/Big_Virology/BVHomePage.html>.

Cells Alive! (Web site). <http://www.cellsalive.com/>.

Centers for Disease Control and Prevention (Web site). <http://www.cdc.gov/>.

Infection Index. Spencer S. Eccles Health Sciences Library, University of Utah (Web site). <http://medlib.med.utah.edu/WebPath/INFEHTML/INFECIDX.html>.

"Oral Health Topic: Infection Control." American Dental Association (Web site). <http://www.ada.org/public/topics/infection.html>.

The Race Against Lethal Microbes: Learning to Outwit the Shifty Bacteria, Viruses, and Parasites That Cause Infectious Diseases. Chevy Chase, MD: Howard Hughes Medical Institute, 1996.

Virtual Museum of Bacteria. Bacteria Information from the Foundation for Bacteriology (Web site). <http://www.bacteriamuseum.org/>.

Weinberg, Winkler G. No Germs Allowed!: How to Avoid Infectious Diseases at Home and on the Road. New Brunswick, NJ: Rutgers University Press, 1996.

KEY TERMS

ANTIBIOTIC:

A substance produced by or derived from a microorganism, which in diluted form is capable of killing or at least inhibiting the action of another microor ganism. Antibiotics are not usually effective against viruses.

ANTISEPSIS:

The practice of inhibiting the growth and multiplication of microorganisms, generally by ensuring the cleanliness of the environment.

BACTERIOLOGY:

An area of the bio logical sciences concerned with bacteria, including their importance in medicine, industry, and agriculture.

DNA:

Deoxyribonucleic acid, a molecule in all cells, and many viruses, containing genetic codes for inheritance.

ENDOGENOUS:

A term for an infection that occurs when the body's resistance is lowered. Compare with exogenous.

EPIDEMIC:

Affecting or potentially affecting a large proportion of a popula tion (adj. ) or an epidemic disease (n. )

EPIDEMIOLOGY:

An area of the medical sciences devoted to the study of disease, including its incidence, distribution, and control within a population.

ETIOLOGY:

A branch of medical study concerned with the causes and origins of disease; also, a general term referring to all the causes of a particular disease or condition.

EXOGENOUS:

A term for an infection that originates outside the body. Compare with endogenous.

GENE:

A unit of information about a particular heritable (capable of being inherited) trait that is passed from parent to offspring, stored in DNA molecules called chromosomes.

GERM THEORY:

A theory in medicine, widely accepted today, that infections, contagious diseases, and other conditions are caused by the actions of microorganisms.

IMMUNITY:

The condition of being able to resist a particular disease, particularly through means that prevent the growth and development of pathogens or counteract their effects.

IMMUNOLOGY:

The study of the immune system, immunity, and immune responses.

INFECTION:

A state or condition in which parasitic organisms attach them selves to the body or to the inside of the body of another organism, producing contamination and disease in the host.

INOCULATION:

The prevention of a disease by the introduction to the body, in small quantities, of the virus or other microorganism that causes the disease.

MUTATION:

Alteration in the physical structure of an organism's DNA, resulting in a genetic change that can be inherited.

PANDEMIC:

Affecting an extremely high proportion of a population over a wide geographic area (adj. ) or a disease of pandemic proportions (n. )

PARASITE:

A general term for any organism that depends on another organism for support, which it receives at the expense of the other organism.

PARASITOLOGY:

A biological discipline devoted to the study of parasites, primarily those among the animal and protist kingdoms. Parasitic bacteria, fungi, and viruses usually are studied within the context of infectious diseases.

PATHOGEN:

A disease-carrying para site, typically a microorganism.

PATHOLOGY:

The study of the essential nature of diseases.

PUBLIC HEALTH:

A set of policies and methods for protecting and improving the health of a community through efforts that include disease prevention, health education, and sanitation.

RNA:

Ribonucleic acid, the molecule translated from DNA in the cell nucleus, the control center of the cell, that directs protein synthesis in the cytoplasm, or the space between cells.

VACCINE:

A preparation containing microorganisms, usually either weakened or dead, which is administered as a means of increasing immunity to the disease caused by those microorganisms.

VECTOR:

An organism, such as an insect, that transmits a pathogen to the body of a host.

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Infection Control

Infection Control

Definition

Infection control refers to policies and procedures used to minimize the risk of spreading infections, especially in hospitals and human or animal health care facilities.

Purpose

The purpose of infection control is to reduce the occurrence of infectious diseases. These diseases are usually caused by bacteria or viruses and can be spread by human to human contact, animal to human contact, human contact with an infected surface, airborne transmission through tiny droplets of infectious agents suspended in the air, and, finally, by such common vehicles as food or water. Diseases that are spread from animals to humans are known as zoonoses; animals that carry disease agents from one host to another are known as vectors.

Infection control in hospitals and other health care settings

Infections contracted in hospitals are also called nosocomial infections. They occur in approximately 5% of all hospital patients. These infections result in increased time spent in the hospital and, in some cases, death. There are many reasons nosocomial infections are common, one of which is that many hospital patients have a weakened immune system which makes them more susceptible to infections. This weakened immune system can be caused either by the patient's diseases or by treatments given to the patient. Second, many medical procedures can increase the risk of infection by introducing infectious agents into the patient. Thirdly, many patients are admitted to hospitals because of infectious disease. These infectious agents can then be transferred from patient to patient by hospital workers or visitors.

Infection control has become a formal discipline in the United States since the 1950s, due to the spread of staphylococcal infections in hospitals. Because there is both the risk of health care providers acquiring infections themselves, and of them passing infections on to patients, the Centers for Disease Control and Prevention (CDC) established guidelines for infection control procedures. In addition to hospitals, infection control is important in nursing homes, clinics, child care centers, and restaurants, as well as in the home.

To lower the risk of nosocomial infections, the CDC began a national program of hospital inspection in 1970 known as the National Nosocomial Infections Surveillance system, or NNIS. The CDC reported that over 300 hospitals participate in the NNIS system as of the early 2000s. Data collected from the participating hospitals show that infection control programs can siginificantly improve patient safety, lower infection rates, and lower patient mortality.

Dental health care settings are similar to hospitals in that both personnel and equipment can transmit infection if proper safeguards are not observed. The CDC issued new guidelines in 2003 for the proper maintenance and sterilization of dental equipment, hand hygiene for dentists and dental hygienists, dental radiology, medications, and oral surgery, environmental infection control, and standards for dental laboratories.

Selected Infectious Diseases And Corresponding Treatment
Disease Symptoms Transmittal Treatment
Chicken pox Rash, low-
grade fever
Person to
person
None
Common
cold/
Influenza
Runny nose,
sore throat,
cough,
fever,
headache,
muscle aches
Person to
person
None
Hepatitis Jaundice, flu-
like symptoms
Sexual contact
with an
infected per-
son, contami-
nated blood,
food, or water
None
Legionnaire's
Disease
Flu symptoms,
peneumonia,
diarrhea,
vomiting,

kidney failure,
respiratory
failure
Air condition-
ing or water
systems
Antibiotics
Measles Skin rash,
runny nose and
eyes, fever,
cough
Person to
person
None
Meningitis Neck pain,
headache, pain
caused by
exposure to
light, fever,
nausea,
drowsiness
Person to
person
Antibiotics
for bacterial
meningitis,
hospital care
for viral
meningitis
Mumps Swelling of
salivary glands
Person to
person
Anti-inflam-
matory
drugs
Ringworm Skin rash Contact with
infected ani-
mal or person
Antifungal
drugs
applied
topically
Tetanus Lockjaw, other
spasms
Soil infection
of wounds
Antibiotics,
antitoxins,
muscle
relaxers

The newest addition to the infection control specialist's resources is molecular typing, which speeds up the identification of a disease agent. Rapid identification in turn allows for timely containment of a disease outbreak.

ELIZABETH LEE HAZEN (18851975)

Elizabeth Lee Hazen was born on August 24, 1885, in Rich, Mississippi. Hazen, born the middle of three children to Maggie (Harper) and William Edgar Hazen, was orphaned before she turned four. She and her sister went to live with their aunt and uncle shorly after her younger brother died. Hazen attended the Mississippi Industrial Institute and College at Columbus, receiving her B.S. degree in 1910. During college, Hazen became interested in science and she studied biology at Columbia University, earning her M.S. in 1917. After working in the U.S. Army laboratories during World War I, she returned to Columbia where she received her Ph.D. in microbiology in 1927. Following her work as an instructor at Columbia, Hazen accepted a position with the New York Department of Health where she researched bacterial diseases.

In 1948, Hazen and Rachel Brown began researching fungal infections found in humans due to antibiotic treatments and diseases. Some of the antibiotics they discovered did indeed kill the fungus; however, they also killed the test mice. Finally, Hazen located a micro-organism on a farm in Virginia, and Brown's tests indicated that the microorganism produced two antibiotics, one of which proved effective for treating fungus and candidiasis in humans. Brown purified the antibiotic which was patented under the name nystatin. In 1954, the antibiotic became available in pill form. Hazen and Brown continued their research and discovered two other antibiotics. Hazen received numerous awards individually and with her research partner, Rachel Brown. Elizabeth Hazen passed away on June 24, 1975.

Threat of emerging infectious diseases

Due to constant changes in our lifestyles and environments, new diseases are constantly appearing that people are susceptible to, making protection from the threat of infectious disease urgent. Many new contagious diseases have been identified in the past 30 years, such as AIDS, Ebola, and hantavirus. Increased travel between continents makes the worldwide spread of disease a bigger concern than it once was. Additionally, many common infectious diseases have become resistant to known treatments.

The emergence of the severe acute respiratory syndrome (SARS) epidemic in Asia in February 2003 was a classic instance of an emerging disease that spread rapidly because of the increased frequency of international and intercontinental travel. In addition, the SARS outbreak demonstrated the vulnerability of hospitals and health care workers to emerging diseases. Clusters of cases within hospitals occurred in the early weeks of the epidemic when the disease had not yet been recognized and the first SARS patients were admitted without isolation precautions.

The SARS epidemic also raised a number of ethical and legal questions regarding current attitudes toward infection control.

Problems of antibiotic resistance

Because of the overuse of antibiotics, many bacteria have developed a resistance to common antibiotics. This means that newer antibiotics must continually be developed in order to treat an infection. However, further resistance seems to come about almost simultaneously. This indicates to many scientists that it might become more and more difficult to treat infectious diseases. The use of antibiotics outside of medicine also contributes to increased antibiotic resistance. One example of this is the use of antibiotics in animal husbandry. These negative trends can only be reversed by establishing a more rational use of antibiotics through treatment guidelines.

Bioterrorism

The events of September 11, 2001, and the anthrax scare that followed in October 2001 alerted public health officials as well as the general public to the possible use of infectious disease agents as weapons of terrorism. The Centers for Disease Control and Prevention (CDC) now has a list of topics and resources related to bioterrorism on its web site.

Description

The goals of infection control programs are: immunizing against preventable diseases, defining precautions that can prevent exposure to infectious agents, and restricting the exposure of health care workers to an infectious agent. An infection control practitioner is a specially trained professional, oftentimes a nurse, who oversees infection control programs.

Commonly recommended precautions to avoid and control the spread of infections include:

  • Vaccinate people and pets against diseases for which a vaccine is available. As of 2003, the vaccines used against infectious diseases are very safe compared to most drugs.
  • Wash hands often.
  • Cook food thoroughly.
  • Use antibiotics only as directed.
  • See a doctor for infections that do not heal.
  • Avoid areas with a lot of insects.
  • Be cautious around wild or unfamiliar animals, or any animals that are unusually aggressive. Do not purchase exotic animals as pets.
  • Do not engage in unprotected sex or in intravenous drug use.
  • Find out about infectious diseases when you make travel plans. Travelers' advisories and adult vaccination recommendations are available on the CDC web site or by calling the CDC's telephone service at 404-332-4559.

Because of the higher risk of spreading infectious disease in a hospital setting, higher levels of precautions are taken there. Typically, health care workers wear gloves with all patients, since it is difficult to know whether a transmittable disease is present or not. Patients who have a known infectious disease are isolated to decrease the risk of transmitting the infectious agent to another person. Hospital workers who come in contact with infected patients must wear gloves and gowns to decrease the risk of carrying the infectious agent to other patients. All articles of equipment that are used in an isolation room are decontaminated before reuse. Patients who are immunocompromised may be put in protective isolation to decrease the risk of infectious agents being brought into their room. Any hospital worker with infections, including colds, are restricted from that room.

Hospital infections can also be transmitted through the air. Thus care must be taken when handling infected materials so as to decrease the numbers of infectious agents that become airborne. Special care should also taken with hospital ventilation systems to prevent recirculation of contaminated air.

Resources

BOOKS

Beers, Mark H., MD, and Robert Berkow, MD, editors. "Immunizations for Adults." Section 13, Chapter 152. In The Merck Manual of Diagnosis and Therapy. Whitehouse Station, NJ: Merck Research Laboratories, 2004.

PERIODICALS

Ashford, D. A., R. M. Kaiser, M. E. Bales, et al. "Planning Against Biological Terrorism: Lessons from Outbreak Investigations." Emerging Infectious Diseases 9 (May 2003): 515-519.

Gostin, L. O., R. Bayer, and A. L. Fairchild. "Ethical and Legal Challenges Posed by Severe Acute Respiratory Syndrome: Implications for the Control of Severe Infectious Disease Threats." Journal of the American Medical Association 290 (December 24, 2003): 3229-3237.

Ho, P. L., X. P. Tang, and W. H. Seto. "SARS: Hospital Infection Control and Admission Strategies." Respirology 8, Supplement (November 2003): S41-S45.

Jacobson, R. M., K. S. Zabel, and G. A. Poland. "The Overall Safety Profile of Currently Available Vaccines Directed Against Infectious Diseases." Expert Opinion on Drug Safety 2 (May 2003): 215-223.

Jarvis, W. R. "Benchmarking for Prevention: the Centers for Disease Control and Prevention's National Nosocomial Infections Surveillance (NNIS) System Experience." Infection 31, Supplement 2 (December 2003): 44-48.

Kohn, W. G., A. S. Collins, J. L. Cleveland, et al. "Guidelines for Infection Control in Dental Health-Care Settings2003." Morbidity and Mortality Weekly Reports: Reports and Recommendations 52, RR-17 (December 19, 2003): 1-61.

Peng, P. W., D. T. Wong, D. Bevan, and M. Gardam. "Infection Control and Anesthesia: Lessons Learned from the Toronto SARS Outbreak." Canadian Journal of Anaesthesiology 50 (December 2003): 989-997.

Petrak, R. M., D. J. Sexton, M. L. Butera, et al. "The Value of an Infectious Diseases Specialist." Clinical Infectious Diseases 36 (April 15, 2003): 1013-1017.

Sehulster, L., and R. Y. Chinn. "Guidelines for Environmental Infection Control in Health-Care Facilities. Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC)." Morbidity and Mortality Recommendations and Reports 52, RR-10 (June 6, 2003): 1-42.

Subramanian, D., J. A. Sandoe, V. Keer, and M. H. Wilcox. "Rapid Spread of Penicillin-Resistant Streptococcus pneumoniae Among High-Risk Hospital Inpatients and the Role of Molecular Typing in Outbreak Confirmation." Journal of Hospital Infection 54 (June 2003): 99-103.

KEY TERMS

Acquired immune deficiency syndrome (AIDS) A disease that weakens the body's immune system. It is also known as HIV infection.

Antibiotic A substance, such as a drug, that can stop a bacteria from growing or destroy the bacteria.

Antibiotic resistance The ability of infectious agents to change their biochemistry in such a way as to make an antibiotic no longer effective.

Bioterrorism The intentional use of disease-causing microbes or other biologic agents to intimidate or terrorize a civilian population for political or military reasons.

Ebola The disease caused by the newly described and very deadly Ebola virus found in Africa.

Epidemiology The branch of medicine that deals with the transmission of infectious diseases in large populations and with detection of the sources and causes of epidemics.

Hantavirus A group of arboviruses that cause hemorrhagic fever (characterized by sudden onset, fever, aching and bleeding in the internal organs).

Immunization Immunity refers to the body's ability to protect itself from a certain disease after it has been exposed to that disease. Through immunization, also known as vaccination, a small amount of an infectious agent is injected into the body to stimulate the body to develop immunity.

Immunocompromized Refers to the condition of having a weakened immune system. This can happen due to genetic factors, drugs, or disease.

Nosocomial infection An infection acquired in a hospital setting.

Staphylococcal infection An infection caused by the organism Staphlococcus. Infection by this agent is common and is often resistant to antibiotics.

Vector An animal carrier that transfers an infectious organism from one host to another.

Zoonosis (plural, zoonoses) Any disease of animals that can be transmitted to humans under natural conditions. Lyme disease, rabies, psittacosis (parrot fever), cat-scratch fever, and monkeypox are examples of zoonoses.

ORGANIZATIONS

American College of Epidemiology. 1500 Sunday Drive, Suite 102, Raleigh, NC 27607. (919) 861-5573. http://www.acepidemiology.org.

American Public Health Association (APHA). 800 I Street NW, Washington, DC 20001-3710. (202) 777-APHA. http://www.apha.org.

American Veterinary Medical Association (AVMA). 1931 North Meacham Road, Suite 100, Schaumburg, IL 60173-4360. http://www.avma.org.

Centers for Disease Control and Prevention. 1600 Clifton Rd., NE, Atlanta, GA 30333. (800) 311-3435, (404) 639-3311. http://www.cdc.gov.

National Institute of Allergy and Infectious Diseases (NIAID). 31 Center Drive, Room 7A50 MSC 2520, Bethesda, MD, 20892. (301) 496-5717. http://www.niaid.nih.gov.

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Infection Control

Infection control

Microorganisms are easily transmitted from place to place via vectors such as insects or animals, by humans that can harbor the infectious organism and shed them to the environment, and via movement through the air (in the case of some bacteria , yeast , and viruses ). Microorganisms can adapt to antimicrobial treatments (the best example being the acquisition of inheritable antibiotic resistance by bacteria). Thus, the potential for the spread of infection by disease-causing microbes is substantial unless steps are taken to limit the spread. Such strategies are collectively termed infection control.

For many microorganisms, particularly bacteria, contact transmission is a common means of spread of infection. This can involve the fecal-oral route, where hands soiled by exposure to feces are placed in the mouth. Day care workers and the infants under their charge are a significant focus of such Escherichia coli infections. As well, touching a contaminated inanimate surface is a means of transmitting an infectious microorganism.

The contact route of transmission is the most common route in the hospital setting. Various steps can be taken to control the spread of infection through contact with contaminated surfaces. Proper handwashing, in fact, is the single most effective means of preventing the spread of infection. Thorough handwashing prevents spread of bacteria to others and also prevents contamination of work or food preparation surfaces.

The operating theatre is an example of a place where the importance of infection control measures is apparent. In the nineteenth century, before the importance of hygienic procedures was recognized, operations were used as a last resort because of the extremely high mortality rate after surgery. Pioneering efforts by scientists such as Joseph Lister made operating rooms much cleaner, which resulted in a drop in the death rate attributable to surgically acquired infections. In the present day, operating rooms are places where personal hygiene is meticulous, instruments and clothing is sterile, and where post-operative clean up is scrupulous.

In hospitals and particularly in research settings, the control of infections involves the use of filters that can be placed in the ventilation systems. Such filters prevent the movement of particles even as small as viruses from a containment area to other parts of a building. Work surfaces are kept free of clutter and are exposed to disinfectant both before and after work with microbes, to kill any transient organisms that may be on the inanimate surface. Laboratories often contain containment structures called fume hoods, in which organisms can be worked with isolated from the airflow of the remainder of the lab. Even the nature of the work surface is designed to thwart infection. Surfaces are constructed so as to be very smooth and to be watertight. The presence of crevasses and cracks at the junction between surfaces are ideal spots for the collection and breeding of infectious microorganisms.

Some infectious microorganisms can be transferred by animal or insect vectors. One example is the viral agent of Yellow Fever , which is transmitted to humans via the mosquito. Control of such an infection can be challenging. Typically a concerted campaign to kill the breeding population of the vector is required, along with measures to protect people from those vectors that might escape the eradication campaign. To use the Yellow Fever example, spraying in mosquito breeding sites could be supplemented with the use of mosquito netting over the beds of people in particularly susceptible regions.

Another strategy of infection control is the use of antimicrobial or antiviral agents in an effort to either defeat an infection or, in the case of vaccines, to protect against the spread of an infection. Antibiotics are an antimicrobial agent. They have been in common use for less than 75 years, and already history is showing that antibiotics achieve success but that this success should not be assumed to be everlasting. Bacteria are proving to be adept at acquiring resistance to many antibiotics. Indeed, already strains of enterococci and Staphylococcus aureus are known to be resistant to virtually all antibiotics currently in use.

Immunization against infection is a widely practiced and successful infection control strategy. Depending upon the target microbe, the vaccination program may be undertaken to prevent the seasonal occurrence of a malady such as influenza , or to eradicate the illness on a worldwide scale. An example of the latter is the World Health Organization's effort to eradicate polio.

One breeding ground for the development of resistant microbial populations is the hospital. Antibiotics and disinfectants are an important part of the infection control strategy in place in most hospitals. Bacteria are constantly exposed to antibacterial agents. The pressure to adapt is constant.

The degree of infection control is tailored to the institution. For example, in a day care facility, the observance of proper hygiene and proper food preparation may be adequate to protect staff and children. However, in a hospital or nursing home, where people are frequently immunocompromised, additional measures need to be taken to ensure that microbes do not spread. Such measures can include regular disinfection of surfaces, one-time use of specific medical equipment such as disposable needles, and well-functioning ventilation systems.

The focus of infection control strategies has shifted with the emerging knowledge in the 1970s and 1980s of the existence and medical relevance of the adherent bacterial populations known as biofilms. These adherent growths can remain viable on surfaces after being treated with concentrations of chemicals that swiftly kill their free-floating counterparts. Infection control in areas such as physician and dentist offices, now focus on ensuring that equipment is free from biofilms, because the bacteria could be easily transferred from the equipment to a patient.

See also Bacteria and bacterial infection; Disinfection and disinfectants; Epidemics and pandemics; Hygiene

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infection

infection The normal human body is covered with billions of harmless microorganisms: indeed, we each carry more bacteria than the total human population of the world! These, together with the skin and the immune system, serve to protect the body from invasion by harmful, or ‘pathogenic’ microorganisms.

If there is a breach in one of these lines of defence, these pathogens can gain access to the body. Entry may be, for example, via a skin wound, inhalation, ingestion, or sexual intercourse, and may be facilitated by immune deficiency or loss of the normal organisms living on the body, for instance after a course of antibiotics.

As soon as the immune system detects the presence of a pathogen it mounts a response to kill it, which is highly successful in most cases in healthy people. On the rare occasions where it fails, or in people with poorly functioning immune systems, the organism may succeed in establishing itself and cause disease: an infection occurs. The term ‘infection’ therefore encompasses not only the classical ‘infectious diseases’, but also such diseases as boils, thrush, urinary tract infection, and surgical wound infections.

The immune response produces a syndrome of inflammation at the site of the infection. This is characterized by redness, warmth, pain, and swelling, caused by extra blood supply to the area bringing white blood cells to fight the infection. Pus may be formed (a mixture of white cells, dead tissue, and organisms). Usually this stops the infection from spreading. However, if the organisms gain entry to the bloodstream, sepsis or ‘blood poisoning’ may ensue. In sepsis the body's white cells respond by producing vast amounts of chemicals which, as well as helping to kill the marauders, result in fever, flushing, shivering, low blood pressure, rapid heart rate, and, in severe cases, delirium. Sometimes this immune response is more harmful than the infection itself. Conversely, sepsis may be difficult to recognize in patients with suppressed immune systems who cannot mount such a florid response. Finally, some microorganisms are not easily recognized by the immune system at all, so that infection may have few if any symptoms until later in the course of the disease when damage to the body by the organism is well advanced. Examples are the human immunodeficiency virus which causes AIDS, and the prion causing Creutzfeld-Jacob disease.

Hospital infection and antisepsis

For many hundreds of years, fevers and infections were believed to be caused by ‘miasmas’, or noxious air exuding from rotten materials. In the nineteenth century the most notorious, and perhaps the most tragic, manifestation of sepsis was puerperal sepsis, or childbed fever, in which the dangerous bacterium Streptococcus pyogenes (now known as the Group A streptococcus) gained entry to the bloodstream via the birth canal. It had a very high fatality rate and was responsible for the deaths of countless young mothers every year. Although well-recognized as a complication of childbirth, the cause was not understood. The Hungarian obstetrician Ignaz Semmelweis, working in Vienna in the 1850s, was particularly concerned by the high rate of childbed fever on one of his wards which was attended by medical students. On this ward nearly a fifth of his patients died of sepsis. On his other ward, attended only by midwives, the rate was only about 3%. He realized that the medical students came directly from the autopsy room to the obstetric ward and proceeded to examine the patients without even washing their hands in between. He insisted that each student should wash his hands with soap and water and then an antiseptic before entering the ward, and saw the mortality rate drop immediately to less than 2%. Thus he proved not only transmission by hand of an infectious agent, but also that it could be prevented by use of antisepsis.

This was a dramatic result, but despite this Semmelweis was ignored and even ridiculed. It was Joseph Lister, working in Glasgow in the late 1860s, who brought about the general acceptance of surgical antisepsis. He used carbolic acid to transform surgery from a highly dangerous last resort to the treatment of choice in many conditions. Florence Nightingale did the same for hospitals after the Crimean War, during which she had shown that cleanliness and hygiene were paramount in preventing injured soldiers from dying of infections — although, ironically, she never believed in the germ theory of disease, rather she believed that filth and dirt bred disease directly.

Since then the refinement of antisepsis before and during operations has been one of the most important developments in allowing the practice of surgery as we now know it. Even now, maintaining a low infection rate is one of the priorities of every surgeon. Low levels are attained by the use of ‘asepsis’ — that is, sterilizing the instruments so that no microorganisms are present on them — and ‘antisepsis’ — the use of chemical solutions to decrease the number of the patient's and the surgeon's own microorganisms as far as possible. Nowadays, one of the greatest challenges facing hospital infection control is the prevention of spread of bacteria that are resistant to many antibiotics, such as methicillin-resistant Straphylococcus aureus (MRSA).

Angharad Puw Davies


See also infectious diseases; microorganisms.

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infection

infection, invasion of plant or animal tissues by microorganisms, i.e., bacteria, viruses, viroids, fungi, rickettsias, and protozoans. The invasion of body tissues by parasitic worms and other higher organisms is commonly referred to as infestation.

Invading organisms such as bacteria produce toxins that damage host tissues and interfere with normal metabolism; some toxins are actually enzymes that, by breaking down host tissues, prevent the localization of infections. Other bacterial substances destroy the host's phagocytes. Viruses and retroviruses are parasitic on host cells, causing cellular degeneration, as in rabies, poliomyelitis, and AIDS, or cellular proliferation, as in warts and cold sores. Some viruses have been associated with the development of certain cancers. Substances produced by many invading organisms cause allergic sensitivity in the host; the immune response to virus infection has been implicated in some diseases (see allergy).

Infections may be spread via respiratory droplets, direct contact, contaminated food, or vectors, such as insects. They can also be transmitted sexually (see sexually transmitted diseases) and from mother to fetus. Immunity is the term used to describe the capacity of the host to respond to infection. Drugs that help fight infections include antibiotics and antiviral drugs.

See also specific diseases, diseases of plants.

See J. Waller, The Discovery of the Germ (2003).

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infection

infection The invasion of any living organism by disease-causing microorganisms (see pathogen), which proceed to establish themselves, multiply, and produce various symptoms in their host. Pathogens may invade via a wound or (in animals) through the mucous membranes lining the alimentary, respiratory, and reproductive tracts, and may be transmitted by an infected individual, a carrier, or an arthropod vector. Symptoms in animals appear after an initial symptomless incubation period and typically consist of localized inflammation, often with pain and fever. Infections are combated by the body's natural defences (see immune response). Treatment with drugs (see antibiotics; antiseptic) is effective against most bacterial, fungal, and protozoan infections; some viral infections respond to antiviral drugs. See also immunization.

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Infection

Infection

An infection is an illness caused by microorganisms or bacteria that invade the body. The body's defenses against infections begin with blocking the entry of microorganisms into the system. Hand washing is an effective strategy in preventing the entry of microorganisms into the body through the skin, the respiratory system , or the GI (gastrointestinal ) tract.

Local infections may produce redness, tenderness, and swelling, but systemic infections produce more serious symptoms such as fever, chills, sweats, and fatigue . Many infections will go away on their own, however, as the body's immune system can successfully fight off many infections. Others, however, require treatment, such as the use of antibiotic medications.

see also Immune System.

Catherine Christie

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infection

infection (in-fek-shŏn) n. invasion of the body by harmful organisms (pathogens), such as bacteria, fungi, protozoa, rickettsiae, or viruses. The infective agent may be transmitted by a patient or carrier in airborne droplets or by direct contact; by animal or insect vectors; by ingestion of contaminated food or drink; or from an infected mother to the fetus. After an incubation period symptoms appear, usually consisting of either localized inflammation and pain or more remote effects. Treatment with drugs is usually effective against most infections, but there are few specific treatments for many common viral infections.
http://guidance.nice.org.uk/CG2 NICE guidance on infection control

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Infection

Infection

How Does Infection Occur?

Where Does Infection Occur?

How Do Infections Lead to Illness?

Do Infections Always Cause Illness?

How Do Infections Spread?

What Are the Symptoms of Infection?

What Is the Treatment for Infection?

How Are Infections Prevented?

Resources

Infection is a process in which bacteria, viruses, fungi or other organisms enter the body, attach to cells, and multiply. To do this, they must evade or overcome the bodys natural defenses at each step. Infections have the potential to cause illness, but in many cases the infected person does not get sick.

KEYWORDS

for searching the Internet and other reference sources

Antibiotics

Immunization

Infection

Inflammation

How Does Infection Occur?

Organisms that can cause illness are all around us: in air, water, soil, and food, as well as in the bodies of animals and other people. Infection occurs when some of them get past a series of natural defenses. Those defenses include:

  • Skin: The skin physically blocks germs, but may let them in if it is cut or scraped.
  • Coughing deeply: This expels germs from the lungs and breathing passages but may be less effective for weak, sick, or injured people.
  • Bacteria: Called resident flora, harmless bacteria normally are present in some parts of the body. They compete with harmful germs and crowd them out. But they can be weakened or killed by medications, allowing harmful germs to thrive and cause illness.
  • Inflammatory response: This is produced by the bodys immune system. Certain kinds of white blood cells-including macrophages and neutrophils-surround and destroy or otherwise attack any kind of germs, often causing fever, redness, and swelling.
  • Antibodies: These are proteins produced by the immune system. Some are targeted to attack specific microbes. This response is also called humoral immunity. Usually these antibodies are produced after a person is infected by or exposed to the microbe.

The immune systems responses may fail if the germs are too numerous, or if they are too virulent. Virulent, from the Latin for poisonous, describes germs that are particularly good at countering the bodys defenses. For instance, some microbes can prevent antibodies from forming against them. Another important factor is the functioning of the immune system. If it is damaged-weakened, for instance, by age or illness-infection is more likely. Babies tend to get more infections because their immune systems have not yet learned to recognize and attack some microbes.

Where Does Infection Occur?

Localized infections

Localized infections remain in one part of the body. Examples include a cut on the hand that gets infected with bacteria, but does not cause problems anywhere else. Localized infections can be very serious if they are internal, such as in the appendix (appendicitis) or in the heart (endocarditis).

Systemic infections

Most serious infections, however, occur when the microorganisms spread throughout the body, usually in the bloodstream. These are called systemic infections, and they include flu, malaria, AIDS, tuberculosis, plague, and most of the infectious diseases whose names are familiar.

How Do Infections Lead to Illness?

The major causes of infection are viruses, bacteria, fungi, and parasites, including protozoa (one-celled organisms), worms, and insects such as mites (which cause scabies) and lice.

Bacteria can release toxins, or poisons. Viruses can take over cells and prevent them from doing their normal work. Bacteria and fungi- and larger infective agents like worms or other parasites-can multiply so rapidly that they physically interfere with the functioning of the lungs, heart, or other organs. The immune response itself-which can bring fever, pain, swelling, and fatigue-often is the major cause of the sick feelings an infected person gets.

Do Infections Always Cause Illness?

No, often they do not. Of people infected with tuberculosis bacteria, for instance, only about one in ten will ever get sick. Some viruses and parasites, too, can remain in the body a lifetime without causing illness. In such cases, called latent infection, people usually get sick only if the immune system weakens.

How Do Infections Spread?

The organisms that cause infections may spread through water, soil, food, or air; through contact with an infected persons blood, skin, or mucus; through sexual contact; or through insect bites. Most germs spread by a couple of these routes; no one microbe spreads in all these ways. In addition, many disease-causing microbes can spread from a pregnant woman to her fetus. When this happens, we say the baby is born with a congenital infection.

What Are the Symptoms of Infection?

The symptoms vary greatly depending on the part of the body and type of organism involved. The first sign of bacterial infection is often inflammation: fever, pain, swelling, redness, and pus. By contrast, viral infections less commonly cause inflammation but may cause a variety of other symptoms, from a runny nose or sore throat to a rash or swollen lymph nodes*.

* lymph nodes
are round masses of tissue that contain immune cells to filter out harmful microorganisms. During infections, lymph nodes may become enlarged.

What Is the Treatment for Infection?

The main treatment is usually medication: antibiotics for bacterial infections; antiviral drugs for some viruses (for most there is no treatment); antifungal medications for fungus infections; and antihelmintic drugs for worms. In some cases of localized infection, as when an abscess or collection of pus forms, surgery may be necessary to drain the infected area.

How Are Infections Prevented?

Disinfeoting wounds

When a wound occurs, infection may be prevented by washing and covering the wound, using antibacterial ointment or spray, and getting medical attention if the wound is serious.

Immunization

Many systemic infectious diseases can be prevented by immunization. Among them are chickenpox, cholera, diphtheria, hepatitis A and hepatitis B, influenza, Lyme disease, measles, mumps, pertussis (whooping cough), pneumococcal pneumonia, polio, rabies, rubella (German measles), tetanus, typhoid fever, and yellow fever.

Hygiene, sanitation, and public health

Many other systemic infections can be prevented by having a clean public water supply and a sanitary system for disposing of human wastes; by washing hands before handling food; by cooking meats thoroughly; by abstaining from sexual contact; and by controlling or avoiding ticks and mosquitos.

See also

Bacterial Infections

Fungal Infections

Parasitic Diseases

Viral Infections

Worms

Resources

U.S. National Institute of Allergy and Infectious Diseases (NIAID), NIAID Office of Communications and Public Liaison, Building 31, Room 7A-50, 31 Center Drive MSC 2520, Bethesda, MD 20892-2520. NIAID publishes pamphlets about infectious diseases and posts fact sheets and newsletters at its website. http://www.niaid.nih.gov/publications/

The World Health Organization posts fact sheets at its website, covering communicable/infectious diseases, tropical diseases, vaccine preventable diseases, and many other health topics. http://www.who.org/home/map_ht.html

KidsHealth.org, the website created by the Nemours Foundation, has information on dozens of infections. http://KidsHealth.org

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infectious

in·fec·tious / inˈfekshəs/ • adj. (of a disease or disease-causing organism) likely to be transmitted to people, organisms, etc., through the environment. ∎  likely to spread infection: the dogs may still be infectious. ∎  likely to spread or influence others in a rapid manner: her enthusiasm is infectious. DERIVATIVES: in·fec·tious·ly adv. in·fec·tious·ness n.

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infection

in·fec·tion / inˈfekshən/ • n. the process of infecting or the state of being infected: strict hygiene will limit the risk of infection. ∎  an infectious disease: a chest infection. ∎  Comput. the presence of a virus in, or its introduction into, a computer system.

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infection

infection The invasion of the tissues of a plant by a pathogenic microorganism. Sometimes the term is used as a synonym for a disease caused by a micro-organism.

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infection

infection Invasion of the body by disease-causing organisms that become established, multiply and give rise to symptoms.

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infectious

infectious Applied to a disease that can be transmitted from one individual to another.

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infection

infectionashen, fashion, passion, ration •abstraction, action, attraction, benefaction, compaction, contraction, counteraction, diffraction, enaction, exaction, extraction, faction, fraction, interaction, liquefaction, malefaction, petrifaction, proaction, protraction, putrefaction, redaction, retroaction, satisfaction, stupefaction, subtraction, traction, transaction, tumefaction, vitrifaction •expansion, mansion, scansion, stanchion •sanction •caption, contraption •harshen, Martian •cession, discretion, freshen, session •abjection, affection, circumspection, collection, complexion, confection, connection, convection, correction, defection, deflection, dejection, detection, direction, ejection, election, erection, genuflection, imperfection, infection, inflection, injection, inspection, insurrection, interconnection, interjection, intersection, introspection, lection, misdirection, objection, perfection, predilection, projection, protection, refection, reflection, rejection, resurrection, retrospection, section, selection, subjection, transection, vivisection •exemption, pre-emption, redemption •abstention, apprehension, ascension, attention, circumvention, comprehension, condescension, contention, contravention, convention, declension, detention, dimension, dissension, extension, gentian, hypertension, hypotension, intention, intervention, invention, mention, misapprehension, obtention, pension, prehension, prevention, recension, retention, subvention, supervention, suspension, tension •conception, contraception, deception, exception, inception, interception, misconception, perception, reception •Übermenschen • subsection •ablation, aeration, agnation, Alsatian, Amerasian, Asian, aviation, cetacean, citation, conation, creation, Croatian, crustacean, curation, Dalmatian, delation, dilation, donation, duration, elation, fixation, Galatian, gyration, Haitian, halation, Horatian, ideation, illation, lavation, legation, libation, location, lunation, mutation, natation, nation, negation, notation, nutation, oblation, oration, ovation, potation, relation, rogation, rotation, Sarmatian, sedation, Serbo-Croatian, station, taxation, Thracian, vacation, vexation, vocation, zonation •accretion, Capetian, completion, concretion, deletion, depletion, Diocletian, excretion, Grecian, Helvetian, repletion, Rhodesian, secretion, suppletion, Tahitian, venetian •academician, addition, aesthetician (US esthetician), ambition, audition, beautician, clinician, coition, cosmetician, diagnostician, dialectician, dietitian, Domitian, edition, electrician, emission, fission, fruition, Hermitian, ignition, linguistician, logician, magician, mathematician, Mauritian, mechanician, metaphysician, mission, monition, mortician, munition, musician, obstetrician, omission, optician, paediatrician (US pediatrician), patrician, petition, Phoenician, physician, politician, position, rhetorician, sedition, statistician, suspicion, tactician, technician, theoretician, Titian, tuition, volition •addiction, affliction, benediction, constriction, conviction, crucifixion, depiction, dereliction, diction, eviction, fiction, friction, infliction, interdiction, jurisdiction, malediction, restriction, transfixion, valediction •distinction, extinction, intinction •ascription, circumscription, conscription, decryption, description, Egyptian, encryption, inscription, misdescription, prescription, subscription, superscription, transcription •proscription •concoction, decoction •adoption, option •abortion, apportion, caution, contortion, distortion, extortion, portion, proportion, retortion, torsion •auction •absorption, sorption •commotion, devotion, emotion, groschen, Laotian, locomotion, lotion, motion, notion, Nova Scotian, ocean, potion, promotion •ablution, absolution, allocution, attribution, circumlocution, circumvolution, Confucian, constitution, contribution, convolution, counter-revolution, destitution, dilution, diminution, distribution, electrocution, elocution, evolution, execution, institution, interlocution, irresolution, Lilliputian, locution, perlocution, persecution, pollution, prosecution, prostitution, restitution, retribution, Rosicrucian, solution, substitution, volution •cushion • resumption • München •pincushion •Belorussian, Prussian, Russian •abduction, conduction, construction, deduction, destruction, eduction, effluxion, induction, instruction, introduction, misconstruction, obstruction, production, reduction, ruction, seduction, suction, underproduction •avulsion, compulsion, convulsion, emulsion, expulsion, impulsion, propulsion, repulsion, revulsion •assumption, consumption, gumption, presumption •luncheon, scuncheon, truncheon •compunction, conjunction, dysfunction, expunction, function, junction, malfunction, multifunction, unction •abruption, corruption, disruption, eruption, interruption •T-junction • liposuction •animadversion, aspersion, assertion, aversion, Cistercian, coercion, conversion, desertion, disconcertion, dispersion, diversion, emersion, excursion, exertion, extroversion, immersion, incursion, insertion, interspersion, introversion, Persian, perversion, submersion, subversion, tertian, version •excerption

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infectious

infectiousfactious, fractious •anxious • captious •precious, semi-precious •infectious •conscientious, contentious, licentious, pretentious, sententious, tendentious •Athanasius, audacious, bodacious, cactaceous, capacious, carbonaceous, contumacious, Cretaceous, curvaceous, disputatious, edacious, efficacious, fallacious, farinaceous, flirtatious, foliaceous, fugacious, gracious, hellacious, herbaceous, Ignatius, loquacious, mendacious, mordacious, ostentatious, perspicacious, pertinacious, pugnacious, rapacious, sagacious, salacious, saponaceous, sebaceous, sequacious, setaceous, spacious, tenacious, veracious, vexatious, vivacious, voracious •facetious, Lucretius, specious •adventitious, Aloysius, ambitious, auspicious, avaricious, capricious, conspicuous, delicious, expeditious, factitious, fictitious, flagitious, judicious, lubricious, malicious, Mauritius, meretricious, nutritious, officious, pernicious, propitious, repetitious, seditious, siliceous, superstitious, suppositious, surreptitious, suspicious, vicious •noxious, obnoxious •conscious, subconscious, unselfconscious •cautious, tortious •atrocious, ferocious, precocious •Confucius • luscious •bumptious, scrumptious •compunctious, rambunctious

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Infection

Infection

Definition

Infection is the invasion and replication of microorganisms—viruses, bacteria, protozoa, or fungi —in body tissues.

Description

There are thousands of infectious agents that can cause human disease. Although the body is extraordinarily adaptive in its responses to such agents, some-times its preventative measures fail, resulting in disease. A subclinical infection occurs when the body's defensive mechanisms are effective, resulting in no apparent clinical symptoms. When infection persists to cause disease, it is called an acute or chronic infection.

Infectious agents

There are four major classes of organisms that infect the human body:

  • Viruses: Microscopic agents that consist of genetic material coding for the virus's reproduction enclosed in a protective protein coat or lipid membrane. Viruses are obligate intracellular parasites; they cannot replicate without first infecting a cell and exploiting its reproductive capabilities.
  • Bacteria: Microscopic prokaryotic organisms (lacking a nuclear membrane, mitochondria, and other organelles). Two major classes include gram-positive bacteria (surrounded by a protective cell wall) and gram-negative bacteria (surrounded by an outer lipid membrane).
  • Fungi: Eukaryotic organisms (containing distinct organelles and a nucleus enclosed by a nuclear membrane). Fungi can be unicellular (e.g., yeast) or multicellular (e.g., mold).
  • Parasites: Eukaryotic organisms ranging from microscopic, unicellular protozoa to macroscopic arthropods and worms.

Infectious organisms are found everywhere on Earth—in extremes of hot and cold; in acidic and alkaline environments; in air, soil, and water; in our bodies, and on our skin. The human body is colonized by numerous types of bacteria (called normal flora) that reside in the stomach, intestines, colon, upper respiratory tract, and on the skin. Ordinarily, normal flora aids in food digestion, protection against disease, and various other functions. Exogenous infections occur when organisms found outside of the body cause disease, while endogenous infections are caused by the normal flora colonizing sterile tissue sites.

Transmission

There are countless ways in which an individual can become infected with an infectious organism. The mode of transmission depends largely on the type of organism, its size, its structure, its vector (who transmitted it), and other factors. Some common ways that infectious agents are transmitted (and examples of such agents) are:

  • inhalation (Mycobacterium tuberculosis;influenza viruses; Histoplasma capsulatum, a fungus that causes pneumonia)
  • ingestion (Salmonella, Vibrio, Giardia and Listeria species; Escherichia coli)
  • penetration of skin (Clostridium tetani, causative agent of tetanus; Staphylococcus aureus; hepatitis C virus [HCV])
  • sexual transmission (human immunodeficiency virus [HIV]; Neisseria gonorrhoeae; Chlamydia trachomatis)
  • zoonoses or animal contact (flaviviruses; rabies virus; Yersinia pestis, causative agent of bubonic plague)
  • mother-to-child (Rubella virus or German measles; herpes simplex virus [HSV]; varicella-zoster virus or chicken pox)

Role in human health

Response to infection

The human body has three basic means of defense against invading microorganisms: natural barriers, innate non-specific immunity, and antigen-specific immunity. Each protective measure acts at a different time point in infection and varies according to the type of infectious agent.

NATURAL BARRIERS. The first barriers against infection are the skin and mucous membranes (the inner lining of the mouth, nose, vagina, urethra, and upper respiratory tract). Besides providing a physical barrier against the entry of infectious agents, these tissues are inhospitable environments for invading microbes. For example, mucus (a secretion made of protein and sugar molecules) in the upper respiratory tract can trap infectious particles before they go on to colonize the lung; ciliated cells (with hair-like structures on their surface) help flush the particles out of the respiratory tract to be expelled. The gastrointestinal tract (including the stomach and intestines) and the urinary tract (including the bladder and kidneys ) secrete fluids such as gastric juice and bile that create hostile conditions for infectious agents.

The temperature of the human body (normally 98.6°F or 37°C) is itself a mechanism of evading infection. A major elevation of body temperature (i.e., fever ) can slow or prevent the colonization and spread of many microbes and increase the efficiency of immune response.

INNATE NON-SPECIFIC IMMUNE RESPONSE. When an infectious agent is able to evade natural barriers and enter the body, the first responses to its presence are non-specific protective responses. For example, the presence of certain microbial surface molecules activates the complement system (proteins that activate inflammation response and recruit white blood cells to the site of infection). The complement system attracts phagocytic cells such as neutrophils and macrophages, which engulf foreign particles and digest them. (Neutrophils circulate primarily in the blood stream, while machrophages reside in tissues.) Activation of the complement system leads to the classic symptoms of inflammation: pain, fever, erythema (redness), and edema (swelling).

ANTIGEN-SPECIFIC IMMUNE RESPONSE. If nonspecific immunity fails to slow or prevent the spread of a microorganism, another line of defense may be used: antigen-specific immunity. Two classes of white blood cells have a large role in specific immune response; these are B cells (or B lymphocytes) and T cells (or T lymphocytes).

B cells are responsible for the production of antibodies, also called immunoglobulins. Antibodies bind specifically to a foreign particle (called an antigen) so that once antibodies have been produced against a particular invader, the immune system can react more rapidly if that invader enters the body again. Antibodies can also enhance phagocytosis, neutralize toxins, inhibit the binding of microorganisms to human cells, and activate the complement system.

There are two main types of T cells: helper T cells (CD4 type) and cytolytic and suppressor T cells (CD8 type). Helper T cells activate and control immune response by stimulating B cells to produce antibodies. Receptors on the surface of cytolytic T cells recognize cells with surface antigens; the cell is then killed. Suppressor T cells help regulate immune response.

In some cases immune response is over-stimulated, resulting in extensive tissue damage and systemic effects. An example is toxic shock syndrome (TSS), a disease that results from infection with Staphylococcus aureus. Upon infection the bacteria produces a toxin that over-stimulates immune response. The result is a proliferation of T cells and over-secretion of cytokines (small proteins that act as signals between cells of the immune system). The clinical manifestations of this disease are devastating: symptoms start with fever and hypotension (low blood pressure ) and may progress to multiple organ failure and desquamation of the skin (extensive peeling or scaling).

Infection control

In the brochure "An Ounce of Prevention: Keeps the Germs Away," (2000) the Centers for Disease Control and Prevention (CDC) identified some simple and inexpensive means of preventing the spread of infectious diseases. These include:

  • Wash hands frequently.
  • Clean and disinfect.
  • Handle and prepare foods safely.
  • Get immunized.
  • Do not take unnecessary antibiotics (e.g., for viral infections).
  • Keep pets healthy.
  • Avoid contact with wild animals.

KEY TERMS

B cells— White blood cells responsible for the production of antibodies.

Ciliated cells— Cells with hair-like structures that help flush out foreign particles from the human body.

Complement system— Proteins that activate inflammation response and recruit white blood cells to the site of infection.

Endogenous infection— Infection caused by the normal flora of the human body.

Eukaryote— An organism whose cells contain a true nucleus bound by a membrane.

Exogenous infection— Infection caused by microbes found external to the human body.

Normal flora— Types of bacteria and other organisms that colonize the human body without normally causing disease.

Obligate intracellular parasites— Microbes that must remain inside of a cell in order to survive and replicate.

Phagocytosis— Engulfment and digestion of foreign particles and cells by phagocytic cells such as neutrophils and macrophages.

Prokaryote— A cell that contains no true nucleus or membrane-bound organelles.

T cells— White blood cells responsible for activating and controlling immune response.

Resources

BOOKS

Murray, P.R., K.S. Rosenthal, G.S. Kobayashi, and M.A. Pfaller. Medical Microbiology. St. Louis, MO: Mosby, Inc., 1998.

Nicklin, J., K. Graeme-Cook, T. Paget, and R. Killington. "Bacteria and Their Environment." In Instant Notes in Microbiology. Oxford, UK: BIOS Scientific Publishers, Inc., 1999, pp.161-71.

PERIODICALS

Delves, P.J., and I.M. Roitt. "The Immune System: First of Two Parts." New England Journal of Medicine (July 6, 2000): 27-49.

Delves, P.J., and I.M. Roitt. "The Immune System: Second of Two Parts." New England Journal of Medicine (July 13, 2000): 108-17.

Huston, David. "The Biology of the Immune System." Journal of the American Medical Association (December 1997): 1804-14.

ORGANIZATIONS

National Center for Infectious Diseases. Mailstop C-14, 1600 Clifton Road, Atlanta, GA 30333. 〈http://www.cdc.gov/ncidod/〉.

OTHER

"Biology of Infectious Disease." In The Merck Manual of Diagnosis and Therapy Online. 2001. Merck & Co., Inc. 〈http://www.merck.com/pubs/mmanual/section13/chapter150/150a.htm〉.

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Infection

Infection

Resources

Infection describes the process whereby harmful microorganisms enter the body, multiply, and cause disease. Normally the defense mechanisms of the bodys immune system keep infectious microorganisms from becoming established. Those organisms, however, that can evade or diffuse the immune system and therapeutic strategies (e.g., the application of antibiotics) are able to increase their population numbers faster than they can be killed. The population increase usually results in host illness.

There are a variety of ways by which harmful microorganisms can be acquired. Blood contaminated with microbes, such as the viral agents of hepatitis and acquired immunodeficiency syndrome, is one source. Infected food or water is another source that causes illness and death to millions of people around the world every year. A prominent example is the food and water-borne transmission of harmful strains of scherichia coli bacteria. Harmful microbes can enter the body through close contact with infected creatures. Transmission of the rabies virus by an infected raccoon bite and of encephalitis virus via mosquitoes are but two examples. Finally, breathing contaminated air can cause illness. Bacterial spores of the causative bacterial agent of anthrax are readily aerosolized and inhaled into the lungs, where, if sufficient in large enough numbers, can germinate and cause severe illness and even death.

To establish an infection, microbes must defeat two lines of defense of the body. The first line of defense is at body surfaces that act as a barrier guard the boundaries between the body and the outside world. These barriers include the skin, mucous membranes in the nose and throat, and tiny hairs in the nose that act to physically block invading organisms. Organisms can be washed away from body surfaces by tears, bleeding, and sweating. These are non-specific mechanisms of resistance.

The bodys second line of defense involves the specific mechanisms of the immune system, a coordinated response involving a variety of cells and protein antibodies, whereby an invading microorganism is recognized and destroyed. The immune system can be strengthened by vaccination, which supplies or stimulates the creation of antibodies to an organism that the body has not yet encountered.

An increasing cause of bacterial infection is the ability of the bacteria to resist the killing action of antibiotics. Within the past decade, the problem of antibiotic resistant bacteria has become a significant clinical issue. Part of the reason for the development of resistance has been the widespread and sometimes inappropriate use of antibiotics (e.g., use of antibiotics for viral illness because antibiotics are not effective against viruses).

Resistance can have molecular origins. The membrane(s) of the bacteria may become altered to make entry of the antibacterial compound more difficult. Also, enzymes can be made that will destroy or inactivate the antibacterial agent. These resistance mechanisms can be passed on to subsequent generations of bacteria that will then be able to survive in increasing numbers.

Bacteria can also acquire resistance to antibiotics and other antibacterial agents, even components of the immune system, by growing on body surfaces, passages, and tissues. In this mode of growth, termed a biofilm, the bacteria are enmeshed in a sticky polymer produced by the cells. The polymer and the slow, almost dormant, growth rate of the bacteria protect them from antibacterial compounds that would otherwise kill them, and can encourage the bacteria to become resistant to the compounds. Examples of such resistance includes the chronic Pseudomonas aerugi-nosa lung infections experienced by those with cystic fibrosis and infection of artificially implanted material, such as urinary catheters and heart pacemakers.

Bacteria and viruses can also evade immune destruction by entering host cells and tissues. Once inside the host structures they are shielded from immune recognition.

Resources

BOOKS

Callahan, Gerald N. Infection: The Uninvited Universe. New York: St. Martins Press, 2006.

Hart, Tony. Microterrors: The Complete Guide to Bacterial, Viral and Fungal Infections that Threaten Our Health. Tonawanda, NY: Firefly Books, 2004.

Salyers, A.A., and D.D. Whitt. Bacterial Pathogenesis: a Molecular Approach, 2nd ed. Washington, DC: American Society for Microbiology Press, 2001.

OTHER

Centers for Disease Control. National Center for Infectious Disease. <http://www.cdc.gov/ncidod/> (accessed October 31, 2006).

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Notes:
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Infection

Infection

Definition

Infection is the invasion and replication of microorganisms—viruses , bacteria , protozoa, or fungi —in body tissues.

Description

There are thousands of infectious agents that can cause human disease. Although the body is extraordinarily adaptive in its responses to such agents, sometimes its

preventative measures fail, resulting in disease. A subclinical infection occurs when the body's defensive mechanisms are effective, resulting in no apparent clinical symptoms. When infection persists to cause disease, it is called an acute or chronic infection.

Infectious agents

There are four major classes of organisms that infect the human body:

  • Viruses: microscopic agents that consist of genetic material coding for the virus's reproduction enclosed in a protective protein coat or lipid membrane. Viruses are obligate intracellular parasites; they cannot replicate without first infecting a cell and exploiting its reproductive capabilities.
  • Bacteria: microscopic prokaryotic organisms (lacking a nuclear membrane, mitochondria, and other organelles). Two major classes include gram-positive bacteria (surrounded by a protective cell wall) and gram-negative bacteria (surrounded by an outer lipid membrane).
  • Fungi: eukaryotic organisms (containing distinct organelles and a nucleus enclosed by a nuclear membrane). Fungi can be unicellular (e.g., yeast) or multicellular (e.g., mold).
  • Parasites: eukaryotic organisms ranging from microscopic, unicellular protozoa to macroscopic arthropods and worms.

Infectious organisms are found everywhere on Earth—in extremes of hot and cold; in acidic and alkaline environments; in air, soil, and water; in our bodies, and on our skin. The human body is colonized by numerous types of bacteria (called normal flora) that reside in the stomach , intestines, colon, upper respiratory tract, and


KEY TERMS


B cellsWhite blood cells responsible for the production of antibodies.

Ciliated cells —Cells with hair-like structures that help flush out foreign particles from the human body.

Complement system —Proteins that activate inflammation response and recruit white blood cells to the site of infection.

Endogenous infection —Infection caused by the normal flora of the human body.

Eukaryote —An organism whose cells contain a true nucleus bound by a membrane.

Exogenous infection —Infection caused by microbes found external to the human body.

Normal flora —Types of bacteria and other organisms that colonize the human body without normally causing disease.

Obligate intracellular parasites —Microbes that must remain inside of a cell in order to survive and replicate.

Phagocytosis —Engulfment and digestion of foreign particles and cells by phagocytic cells such as neutrophils and macrophages.

Prokaryote —A cell that contains no true nucleus or membrane-bound organelles.

T cellsWhite blood cells responsible for activating and controlling immune response.


on the skin. Ordinarily, normal flora aids in food digestion, protection against disease, and various other functions. Exogenous infections occur when organisms found outside of the body cause disease, while endogenous infections are caused by the normal flora colonizing sterile tissue sites.

Transmission

There are countless ways in which an individual can become infected with an infectious organism. The mode of transmission depends largely on the type of organism, its size, its structure, its vector (who transmitted it), and other factors. Some common ways that infectious agents are transmitted (and examples of such agents) are:

  • inhalation (Mycobacterium tuberculosis;influenza viruses; Histoplasma capsulatum, a fungus that causes pneumonia)
  • ingestion (Salmonella, Vibrio, Giardia and Listeria species; Escherichia coli)
  • penetration of skin (Clostridium tetani, causative agent of tetanus; Staphylococcus aureus; hepatitis C virus [HCV])
  • sexual transmission (human immunodeficiency virus [HIV]; Neisseria gonorrhoeae; Chlamydia trachomatis)
  • zoonoses or animal contact (flaviviruses; rabies virus; Yersinia pestis, causative agent of bubonic plague)
  • mother-to-child (Rubella virus or German measles; herpes simplex virus [HSV]; varicella-zoster virus or chicken pox)

Role in human health

Response to infection

The human body has three basic means of defense against invading microorganisms: natural barriers, innate non-specific immunity, and antigen-specific immunity. Each protective measure acts at a different time point in infection and varies according to the type of infectious agent.

NATURAL BARRIERS. The first barriers against infection are the skin and mucous membranes (the inner lining of the mouth, nose, vagina, urethra, and upper respiratory tract). Besides providing a physical barrier against the entry of infectious agents, these tissues are inhospitable environments for invading microbes. For example, mucus (a secretion made of protein and sugar molecules) in the upper respiratory tract can trap infectious particles before they go on to colonize the lung; ciliated cells (with hair-like structures on their surface) help flush the particles out of the respiratory tract to be expelled. The gastrointestinal tract (including the stomach and intestines) and the urinary tract (including the bladder and kidneys ) secrete fluids such as gastric juice and bile that create hostile conditions for infectious agents.

The temperature of the human body (normally 98.6°F or 37°C) is itself a mechanism of evading infection. A major elevation of body temperature (i.e., fever ) can slow or prevent the colonization and spread of many microbes and increase the efficiency of immune response .

INNATE NON-SPECIFIC IMMUNE RESPONSE. When an infectious agent is able to evade natural barriers and enter the body, the first responses to its presence are non-specific protective responses. For example, the presence of certain microbial surface molecules activates the complement system (proteins that activate inflammation response and recruit white blood cells to the site of infection). The complement system attracts phagocytic cells such as neutrophils and macrophages, which engulf foreign particles and digest them. (Neutrophils circulate primarily in the blood stream, while machrophages reside in tissues.) Activation of the complement system leads to the classic symptoms of inflammation: pain , fever, erythema (redness), and edema (swelling).

ANTIGEN-SPECIFIC IMMUNE RESPONSE. If non-specific immunity fails to slow or prevent the spread of a microorganism, another line of defense may be used: antigen-specific immunity. Two classes of white blood cells have a large role in specific immune response; these are B cells (or B lymphocytes) and T cells (or T lymphocytes).

B cells are responsible for the production of antibodies, also called immunoglobulins. Antibodies bind specifically to a foreign particle (called an antigen) so that once antibodies have been produced against a particular invader, the immune system can react more rapidly if that invader enters the body again. Antibodies can also enhance phagocytosis, neutralize toxins, inhibit the binding of microorganisms to human cells, and activate the complement system.

There are two main types of T cells: helper T cells (CD4 type) and cytolytic and suppressor T cells (CD8 type). Helper T cells activate and control immune response by stimulating B cells to produce antibodies. Receptors on the surface of cytolytic T cells recognize cells with surface antigens; the cell is then killed. Suppressor T cells help regulate immune response.

In some cases immune response is over-stimulated, resulting in extensive tissue damage and systemic effects. An example is toxic shock syndrome (TSS), a disease that results from infection with Staphylococcus aureus. Upon infection the bacteria produces a toxin that over-stimulates immune response. The result is a proliferation of T cells and over-secretion of cytokines (small proteins that act as signals between cells of the immune system). The clinical manifestations of this disease are devastating: symptoms start with fever and hypotension (low blood pressure ) and may progress to multiple organ failure and desquamation of the skin (extensive peeling or scaling).

Infection control

In the brochure "An Ounce of Prevention: Keeps the Germs Away," (2000) the Centers for Disease Control and Prevention (CDC) identified some simple and inexpensive means of preventing the spread of infectious diseases. These include:

  • Wash hands frequently.
  • Clean and disinfect.
  • Handle and prepare foods safely.
  • Get immunized.
  • Do not take unnecessary antibiotics (e.g., for viral infections).
  • Keep pets healthy.
  • Avoid contact with wild animals.

Resources

BOOKS

Murray, P.R., K.S. Rosenthal, G.S. Kobayashi, and M.A. Pfaller. Medical Microbiology. St. Louis, MO: Mosby, Inc., 1998.

Nicklin, J., K. Graeme-Cook, T. Paget, and R. Killington. "Bacteria and their environment." In Instant Notes in Microbiology. Oxford, UK: BIOS Scientific Publishers, Inc., 1999, pp.161-71.

PERIODICALS

Delves, P.J., and I.M. Roitt. "The Immune System: First of two parts." New England Journal of Medicine (July 6,2000): 27-49.

Delves, P.J., and I.M. Roitt. "The Immune System: Second of two parts." New England Journal of Medicine (July 13, 2000): 108-17.

Huston, David. "The Biology of the Immune System." Journal of the American Medical Association (December 1997): 1804-14.

ORGANIZATIONS

National Center for Infectious Diseases. Mailstop C-14, 1600 Clifton Road, Atlanta, GA 30333. <http://www.cdc.gov/ncidod/>.

OTHER

"Biology of Infectious Disease." In The Merck Manual of Diagnosis and Therapy, on-line. 2001. Merck & Co., Inc. <http://www.merck.com/pubs/mmanual/section13/chapter150/150a.htm>.

Stephanie Islane Dionne

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Within the “Cite this article” tool, pick a style to see how all available information looks when formatted according to that style. Then, copy and paste the text into your bibliography or works cited list.

Because each style has its own formatting nuances that evolve over time and not all information is available for every reference entry or article, Encyclopedia.com cannot guarantee each citation it generates. Therefore, it’s best to use Encyclopedia.com citations as a starting point before checking the style against your school or publication’s requirements and the most-recent information available at these sites:

Modern Language Association

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The Chicago Manual of Style

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Infection

Infection

The term infection refers to the state where a host organism has been invaded by another organism, typically a microorganism such as a virus , bacterium, protozoa , algae , or fungus. The invader is able to elude the responses of the host that are designed to kill it. Strategies include rapid multiplication, which can overwhelm the host defenses, or escaping from the host's immune system by multiplying inside host cells.

The second aspect of infection is the presence of symptoms. Depending on the type of infection, the symptoms produced can range from the inconvenience of a cold to those that are life threatening.

Until the middle of the twentieth century, infections posed a serious problem even in developed countries. Throughout recorded history, infections often killed millions of people in epidemics of diseases like bubonic plague and typhoid fever . Even today, infections continue to cause more deaths during times of war and famine than does battle and starvation. Infections can sweep through a population quickly. For example, the acquired immunodeficiency syndrome (AIDS ) has only been known for a little over three decades. Yet, AIDS is now the leading cause of death among African males.

Three factors are important in the control of an infection. These include identifying and eliminating the source of the infection, preventing the spread of the infection, and increasing the resistance of the host to the infecting microbe.

The hundreds of different infections that can occur in humans are caused by five major groups of microbes. These groups are the bacteria , a group made up of Rickettsiae, Coxiella, and Chlamydiae; viruses; fungi ; protozoa; and worms known as Helminths. Infections from most of these organisms can be cured or made less severe using antibiotic drugs and anti-fungal medication. However, there is no cure for viral infections.

Most of the infections that humans acquire come from other people, animals or insects , and from nonliving objects that have infectious microbes adhering to them. Examples include the passage of a cold virus by kissing or sneezing, transfer of infectious viruses by dog or bat bites (i.e., rabies ), use of contaminated needles to inject drugs (i.e., hepatitis B), unprotected sex with a contaminated partner (i.e., AIDS, syphilis). Infections also arise from drinking contaminated water or eating contaminated food.

Infections can become established when the immune system is not functioning properly because of disease , malnutrition , or treatment for another malady (i.e., chemotherapy for cancer ). In these cases, microbes that would otherwise be easily defeated are able to proliferate, causing opportunistic infections.

Other infections arise because of a genetic condition in the host that predisposes the host to infection. One example is the persistent lung infections caused primarily by the bacterium Pseudomonas aeruginosa in some people who have cystic fibrosis . The fluid that accumulates in the lungs enables the bacteria to establish colonies that are resistant to treatment.

Still another route of infection is via the air. This route is especially relevant for bacterial spores, which are so small and light that they can float through the air and be inhaled. A prominent example is Bacillus anthracis, the cause of anthrax .

The concept of resistance to infection also applies to the host. As some bacteria are able resist host defenses and cause infection, so the host has several mechanisms of resistance. The first line of a host's defense is the various surfaces of the body. The skin, mucous membranes in the nose and throat, and tiny hairs in the nose that act to physically block invading organisms. The uppermost cells of the skin secrete chemicals that are lethal to bacteria such as Staphylococcus aureus, a bacterium that can cause skin infections. Microbes can also be washed away from body surfaces by tears, bleeding, and sweating. These are nonspecific mechanisms of resistance.

A host also has a specific defense response, namely the immune system. An invading microbe can be recognized as a foreigner and destroyed. This host resistance can be aided by vaccination, which in some cases provides a life long resistance to a particular organism.

The use of antibiotics was thought to be as powerful a deterrent to infection as vaccination. Indeed, when antibiotics were discovered in the middle of the twentieth century, many infections were presumed to have been defeated. However, this has proved not to be the case. The cause of the failure of some antibiotics is the ability of the target bacteria to become resistant to the drug. In the 1990s, this problem became especially evident, with the emergence of several types of infectious bacteria that are resistant to almost all antibiotics. Indeed, a strain of Staphylococcus aureus is resistant to all currently used antibiotics.

The development of resistance to antimicrobial agents such as antibiotics can have molecular origins. The membrane(s) of the bacteria may become structurally changed so as to make the passage of drugs across the membrane(s) difficult. Secondly, enzymes capable of degrading the antibiotic are produced. The overuse or inappropriate use of antibiotics (i.e., to treat a viral infection, even thought viruses are not affected by antibiotics) has contributed to the development of bacterial resistance, which can be genetically passed on to subsequent generations

The organization of the infecting microorganisms can also be a resistant factor. An example is the resistance that develops as a consequence of the surface growth of bacteria. In this mode of growth, which is known as a biofilm, the bacteria grow inside a sugary coating that is excreted by the surface adhering bacteria. Inside the coating the bacteria become almost dormant. The slow chemical activities of the bacteria, combined with the presence of the protective coating, makes biofilm bacteria extremely hardy. An example of the resistance of biofilm bacteria is that of Pseudomonas aeruginosa. Biofilms of this bacterium cause chronic lung infections in people afflicted with cystic fibrosis, and can grow on artificially implanted material (i.e., urinary catheters and heart pacemakers.)

See also Lymphatic system; Zoonoses.

Resources

books

Kaper, J.B., and A.D. O'Brien. Escherichia coli O157:H7 and Other Shiga Toxin-Producing E. coli Strains. Washington, DC: American Society for Microbiology Press, 1998.

Salyers, A.A., and D.D. Whitt. Bacterial Pathogenesis: A Molecular Approach. 2nd ed. Washington, DC: American Society for Microbiology Press, 2001.

other

Centers for Disease Control. "National Center for Infectious Disease." [cited November 20, 2002] <http://www.cdc.gov/ncidod/>.

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Infection Control

Infection Control

Definition

Infection control is the protection of patients and health care workers by the prevention of infection in the health care setting in a cost-efficient manner.

Purpose

The purpose of infection control is to reduce the risk of health care worker exposure and infection and nosocomial (hospital-acquired) infections, which can complicate existing diseases or injuries.

Description

Organized efforts at infection control began in the United States in the 1950s, along with the increase in intensive care units to care for critically ill patients and the emergence of nonsocomial staphylococcal infections. Many hospitals implemented programs in the 1960s and 1970s at the insistence of various organizations. In the 1980s, state and federal agencies, along with professional organizations, began to make recommendations for infection control and require adherence to regulations.

Infection control procedures are followed in hospitals, long term care facilities, rehabilitation units, outpatient facilities, and home care. All infection control programs should encourage actions that limit the spread of nosocomial infections. All healthcare institutions are mandated by the Joint Commission on

Standard precautions for infection control
Source: CDC, 1996.
Environmental controlFollow hospital procedures for routine care, cleaning, and disinfection of all surfaces, beds, bedrails, bedside equipment, and other frequently touched surfaces.
LinenHandle, transport, and process used linen soiled with blood, body fluids, secretions, or excretions in a manner that prevents exposures and contamination of clothing, and avoids transferring microorganisms to other patients and environments.
Occupational health and bloodborne pathogensPrevent injuries when using needles, scalpels, and other sharp instruments or devices; when handling sharp instruments after procedures; when cleaning used instruments; and when disposing of used needles.
Never recap used needles using both hands or any other technique that involves pointing the needle toward any part of the body; instead, use a one-handed "scoop" technique or a mechanical device designed for holding the needle sheath.
Do not remove used needles from disposable syringes by hand, and do not bend, break, or otherwise manipulate used needles by hand. Place used disposable syringes and needles, scalpel blades, and other sharp items in puncture-resistant sharps containers located as close as practical to the area in which the items were used, and place reusable syringes and needles in a puncture-resistant container for transport to the processing area.
Patient-care equipmentUse resuscitation devices as an alternative to mouth-to-mouth resuscitation.
Handle used patient-care equipment soiled with blood, body fluids, secretions, or excretions in a manner that prevents skin and mucous membrane exposures and contamination of other patients and environments. Ensure that reuasable equipment is not used for the care of another patient until it has been appropriately cleaned and reprocessed and single use items are properly discarded.
Patient placementUse a private room for a patient who contaminates the environment or who does not (or cannot be expected to) assist in maintaining appropriate hygiene or environmental control. Consult Infection Control if a private room is not available.
Wash hands (plain soap)Wash after touching blood, body fluids, secretions, excretions, and contaminated items.
Wash immediately after gloves are removed and between patient contacts.
Avoid transfer of microorganisms to other patients or environments.
Wear glovesWear when touching blood, body fluids, secretions, excretions, and contaminated items.
Put on clean gloves just before touching mucous membranes and nonintact skin.
Change gloves between tasks and procedures on the same patient after contact with material that may contain high concentrations of microorganisms. Remove gloves promptly after use, before touching noncontaminated items and other surfaces, and before going to another patient, and wash hands immediately to avoid transfer of microorganisms to other patients or environments.
Wear gownProtect skin and prevent soiling of clothing during procedures that are likely to generate splashes or sprays of blood, body fluids, secretions, or excretions. Remove a soiled gown as promptly as possible and wash hands to avoid transferring microorganisms to other patients or environments.
Wear mask and eye protection or face shieldProtect mucous membranes of the eyes, nose, and mouth during procedures and patient-care activities that are likely to generate splashes or sprays of blood, body fluids, secretions, or excretions.

Accreditation of Healthcare Organizations (JCAHO) to "develop specific objectives and outcome measures to determine whether or not its infection control goals have been achieved" (AJIC, 1998). Infection control programs must include the means to measure the effectiveness of procedures, policies, or programs to protect patients and health care providers and to determine if these activities are cost-effective.

Health care organizations must be in compliance with regulations and accreditation requirements by various federal and state agencies and governing bodies. JCAHO, for instance, has standards that are incorporated into many state licensing, as well as Medicare and Medicaid, regulations. The facility's administration is responsible for ensuring compliance. Ongoing education and training are an important part of an effective infection control program. Also, the monitoring of patient-care activities can identify areas of concern, and the data obtained is vital to improving the program and ensuring successes.

The Hospital Infections Program (HIP) of the National Center for Infectious Diseases, Centers for Disease Control and Prevention (CDC), is the focus for information, surveillance, investigation, prevention, and control of nosocomial infections for the U.S. Public Health Service, state and local health departments, hospitals, and professional organizations in the United States and around the world. Studies indicate that one-third of nosocomial infections can be prevented by well-organized infection control programs, yet only 6-9% are actually prevented. The Study of Efficacy of Nosocomial Infection Control (SENIC) carried out by HIP over ten years showed that, to be effective, nosocomial infection programs must include the following: 1) organized surveillance and control activities, 2) a ratio of one infection control practitioner for every 250 acute care beds, 3) a trained hospital epidemiologist, and 4) a system for reporting surgical wound infection rates back to surgeons (NNIS, 1996). The National Nosocomial Infections Surveillance (NNIS) System has been gathering information for 20 years regarding nosocomial infections. This information is being used to assist hospitals in conducting successful surveillance of these infections.

In 1987, the Centers for Disease Control (CDC) expanded previous recommendations to prevent the spread of human immunodeficiency virus (HIV), hepatitis B virus (HBV), and other bloodborne pathogens. Previously, certain isolation precautions were recommended only for those patients who were known or suspected to have bloodborne infectious diseases. Because of the growing number of persons infected with HIV and the high mortality rates associated with AIDS, Universal Blood and Body Fluids Precautions were developed. Under these new recommendations, all patients are considered potentially infectious for bloodborne infections. In 1991, the Occupational Safety and Health Administration's (OSHA) Bloodborne Pathogen Standard required the use of universal precautions and dictated that all staff must be trained annually on the risk of exposure to bloodborne pathogens. Preventing exposure is the best and safest way to reduce infection.

The effectiveness of infection control programs are evaluated in several ways: lower rates of infection for the patient, shorter periods of hospital stays, decreased morbidity, and reduction of on-the-job exposure of health care workers to infection and contamination from patients. To do this, infection control policies focus on strategies for isolation, barrier precautions, case investigation, health care worker education, immunization services, and employee health programs. When healthcare institutions are successful in their infection control programs, it decreases the cost of care and has a positive impact on the institution's image within the community.

It is the responsibility of infection control to identify problems, collect and analyze data, change policies and procedures when necessary, and monitor data. The specific functions of an infection control program should be based on the needs of the individual healthcare institution. It is most important to monitor infection activity. Data is collected and disseminated based on the principles of epidemiology to implement quality-improvement activities and improve patient outcomes. Policies and procedures of the facility must be based on scientific and valid infection control prevention and be reviewed and updated frequently to reflect practice guidelines and standards.

Transmission of infection within a health care organization requires three elements: a source of infecting microorganisms, a susceptible host, and a means of transmission for the microorganism. The skin of patients and personnel can function as a reservoir for infectious agents and as a vehicle for transfer of infectious agents to susceptible persons. The microbial flora of the skin consists of resident and transient microorganisms. Resident microorganisms persist and multiply on the skin. Transient microorganisms are contaminants that can survive for only a limited period of time. Most resident microorganisms are found in superficial skin layers, but about 10-20% inhabit deep epidermal layers. Handwashing with plain soaps is effective in removing many transient microorganisms. Resident microorganisms in the deep layers may not be removed by handwashing with plain soaps, but usually can be killed or inhibited by antimicrobial products. Handwashing is the single most important measure for preventing nosocomial infections.

Hand-washing indications

Health care workers should wash their hands:

  • after removing gloves
  • when coming on duty
  • when hands are soiled, including after sneezing, coughing, or blowing the nose
  • between patient contacts
  • before medication preparation
  • after personal use of the toilet
  • before performing invasive procedures
  • before taking care of particularly susceptible patients, such as those who are severely immunocompromised and newborns
  • before and after touching wounds
  • before and after eating
  • after touching inanimate objects that are likely to be contaminated with pathogenic microorganisms, such as urine-measuring devices and secretion collection apparatuses
  • after taking care of infected patients or patients who are likely to be colonized with microorganisms of special clinical or epidemiologic significance; for example, bacteria that are resistant to multiple antibiotics
Methods of disinfection
Method Use
Source: Benarde, M.A., ed. Disinfection: A Treatise. New York: Marcel Dekker, 1970.
AlcoholsSkin degerming.
AutoclavingSterilize instruments not harmed by heat and water pressure.
Boiling waterKill non-spore-forming pathogenic organisms.
ChlorinesWater disinfection; food surface sanitization.
Ethylene oxide gasSterilization of heat-sensitive materials or those that must be kept dry.
Fiberglass filtersAir disinfection.
Formaldehyde (formalin)Drastic disinfection.
Formaldehyde gasFumigation; sterilization of heat-sensitive materials.
Germicidal soaps (hexachlorophene)Skin degerming.
Iodines, tinctureSkin degerming.
Iodines, iodophorsGeneral disinfectant.
IonizingSterilize medicines, some plastics, sutures, and biologicals.
Membrane filtrationWater purification.
MercurialsSkin degerming.
PhenolsGeneral disinfectant.
Quaternary ammonia compounds, tinctureSkin degerming.
Quaternary ammonia compounds, aqueousGeneral disinfectant.
UltrasonicDisinfect instruments.
Ultraviolet lightAir and surface disinfection.
WashingDisinfect hands and surfaces.

Preparation

Routine hand-washing is accomplished by vigorously rubbing together all surfaces of lathered hands followed by thorough rinsing under a stream of water. This should take 10-15 seconds to complete. The hands should be dried with a paper towel. Immediate recontamination of the hands by touching sink fixtures may be avoided by using a paper towel to turn off faucets.

Universal precautions recommend that all health care workers who come into contact with a patient's blood or body fluids that contain visible blood should wear an appropriate type of barrier to prevent the spread of blood-borne pathogens. Other body fluids for which barrier protection is recommended include semen, vaginal secretions, cerebrospinal fluid (CSF), synovial fluid, pleural fluid, pericardial fluid, and amniotic fluid. The type of exposure determines the specific barrier that should be used. Universal precautions are designed to augment, not replace, standard infection control procedures such as hand washing and the use of gloves when touching obviously infected materials.

Adequate routine cleaning and removal of soil should be the environmental sanitation procedure for all healthcare facilities. Microorganisms are normal contaminants of the environment. A healthcare facility's environmental services department should maintain schedules for routine cleaning in all rooms and include equipment and working surfaces. General and infectious wastes are disposed of on a regular schedule. All departments, though, are responsible for implementing infection control policies.

Complications

Health care workers must not be complacent about implementing their facility's infection control policies. Perhaps due to long time-exposure to occupationally acquired infections, they have the tendency to minimize or ignore the ramifications. Infections oftentimes go undetected, underreported, or overlooked by health care workers.

Results

If infection control programs are successful, the result will be a reduction in the risk of infection and related adverse outcomes in the healthcare setting, achieved in a cost-efficient manner.

Health care team roles

Much of the responsibility for infection control rests on the shoulders of the clinical staff providing care at the bedside. Because nurses are close to the patient physically, they are able to prevent the spread of infection, but they can also be a means of transmitting infection. Therefore they need to foster compliance with infection control policies to ensure a high quality outcome for the patient. Infection control practices should have a positive effect on not only the clinical staff, but the patient as well.

Resources

BOOKS

Jennings, J., and F. Manian. APIC Handbook of Infection Control. Washington, D.C.: Association for Professionals in Infection Control and Epidemiology, 1999.

Selected infectious diseases and corresponding treatment
Disease Symptoms Transmittal Treatment
Chicken poxRash, low-grade feverPerson to personNone
Common cold/InfluenzaRunny nose, sore throat, cough, fever, headache, muscle achesPerson to personNone
HepatitisJaundice, flu-like symptomsSexual contact with an infected person, contaminated blood, food, or waterNone
Legionnaire's DiseaseFlu symptoms, pneumonia, diarrhea, vomiting, kidney failure, respiratory failureAir conditioning or water sysemsAntibiotics
MeaslesSkin rash, runny nose and eyes, fever, coughPerson to personNone
MeningitisNeck pain, headache, pain caused by exposure to light, fever, nausea, drowsinessPerson to personAntibiotics for bacterial meningitis, hospital care for viral meningitis
MumpsSwelling of salivary glandsPerson to personAnti-inflammatory drugs
RingwormSkin rashContact with infected animal or personAntifungal drugs applied topically
TetanusLockjaw, other spasmsSoil infection of woundsAntibiotics, antitoxins, muscle relaxers

PERIODICALS

Barrs, A. "Infection Control Across the Board." Nursing Homes Long Term Care Management 49, Issue 11 (November 2000):38.

Henderson, D. "Raising the Bar: The Need for Standardizing the Use of 'Standard Precautions' as a Primary Intervention to Prevent Occupational Exposures to Bloodborne Pathogens." Infection Control and Hospital Epidemiology 22 (February 2001):6.

Heseltine, P. "Why Don't Doctors and Nurses Wash Their Hands?" Infection Control and Hospital Epidemiology 22 (April 2001):4.

Hood, R., and D. Olesen. "Re-evaluating the Role of the Clinical Nurse in Minimizing Health Care Related Infection." Australian Nursing Journal 8 (October 2000):1.

Rello, J. "Impact of Nosocomial Infections on Outcome: Myths and Evidence." Infection Control and Hospital Epidemiology 20 (June 1999):6.

"Requirements for Infrastructure and Essential Activities of Infection Control and Epidemiology in Hospitals: A Consensus Panel Report." Infection Control and Epidemiology 19 (1998):114-124.

Shimkins, J. "Making the Grade." Health Facilities Management 1 (January 1999):18.

Stratton, C. "Occupationally Acquired Infections: A Timely Reminder." Infection Control and Hospital Epidemiology (January 2001):22.

ORGANIZATIONS

Hospital Infections Program. Centers for Disease Control and Prevention. 1600 Clifton Road, Atlanta, GA 30333. 〈http://www.cdc.gov/ncidod/publications/brochures/hip.htm〉.

OTHER

Infection Control: Hand-Washing and Antisepsis. Johns Hopkins University. 2001.

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Infection Control

Infection control

Definition

Infection control is the protection of patients and health care workers by the prevention of infection in the health care setting in a cost-efficient manner.

Purpose

The purpose of infection control is to reduce the risk of health care worker exposure and infection and nosocomial (hospital-acquired) infections, which can complicate existing diseases or injuries.

Description

Organized efforts at infection control began in the United States in the 1950s, along with the increase in intensive care units to care for critically ill patients and the emergence of nonsocomial staphylococcal infections . Many hospitals implemented programs in the 1960s and 1970s at the insistence of various organizations. In the 1980s, state and federal agencies, along with professional organizations, began to make recommendations for infection control and require adherence to regulations.

Infection control procedures are followed in hospitals, long term care facilities, rehabilitation units, outpatient facilities, and home care . All infection control programs should encourage actions that limit the spread of nosocomial infections. All healthcare institutions are mandated by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) to “develop specific objectives and outcome measures to determine whether or not its infection control goals have been achieved” (AJIC, 1998). Infection control programs must include the means to measure the effectiveness of procedures, policies, or programs to protect patients and health care providers and to determine if these activities are cost-effective.

Health care organizations must be in compliance with regulations and accreditation requirements by various federal and state agencies and governing bodies. JCAHO, for instance, has standards that are incorporated into many state licensing, as well as Medicare and Medicaid , regulations. The facility's administration is responsible for ensuring compliance. Ongoing education and training are an important part of an effective infection control program. Also, the monitoring of patient-care activities can identify areas of concern, and the data obtained is vital to improving the program and ensuring successes.

The Hospital Infections Program (HIP) of the National Center for Infectious Diseases, Centers for Disease Control and Prevention (CDC), is the focus for information, surveillance, investigation, prevention, and control of nosocomial infections for the U.S. Public Health Service, state and local health departments, hospitals, and professional organizations in the United States and around the world. Studies indicate that one-third of nosocomial infections can be prevented by well-organized infection control programs, yet only 6–9% are actually prevented. The Study of Efficacy of Nosocomial Infection Control (SENIC) carried out by HIP over ten years showed that, to be effective, nosocomial infection programs must include the following: 1) organized surveillance and control activities, 2) a ratio of one infection control practitioner for every 250 acute care beds, 3) a trained hospital epidemiologist, and 4) a system for reporting surgical wound infection rates back to surgeons (NNIS, 1996). The National Nosocomial Infections Surveillance (NNIS) System has been gathering information for 20 years regarding nosocomial infections. This information is being used to assist hospitals in conducting successful surveillance of these infections.

In 1987, the Centers for Disease Control (CDC) expanded previous recommendations to prevent the spread of human immunodeficiency virus (HIV), hepatitis B virus (HBV), and other bloodborne pathogens. Previously, certain isolation precautions were recommended only for those patients who were known or suspected to have bloodborne infectious diseases. Because of the growing number of persons infected with HIV and the high mortality rates associated with AIDS , Universal Blood and Body Fluids Precautions were developed. Under these new recommendations, all patients are considered potentially infectious for bloodborne infections. In 1991, the Occupational Safety and Health Administration's (OSHA) Bloodborne Pathogen Standard required the use of universal precautions and dictated that all staff must be trained annually on the risk of exposure to bloodborne pathogens. Preventing exposure is the best and safest way to reduce infection.

The effectiveness of infection control programs are evaluated in several ways: lower rates of infection for the patient, shorter periods of hospital stays, decreased morbidity, and reduction of on-the-job exposure of health care workers to infection and contamination from patients. To do this, infection control policies focus on strategies for isolation, barrier precautions, case investigation, health care worker education, immunization services, and employee health programs. When healthcare institutions are successful in their infection control programs, it decreases the cost of care and has a positive impact on the institution's image within the community.

It is the responsibility of infection control to identify problems, collect and analyze data, change policies and procedures when necessary, and monitor data. The specific functions of an infection control program should be based on the needs of the individual healthcare institution. It is most important to monitor infection activity. Data is collected and disseminated based on the principles of epidemiology to implement quality-improvement activities and improve patient outcomes. Policies and procedures of the facility must be based on scientific and valid infection control prevention and be reviewed and updated frequently to reflect practice guidelines and standards.

Transmission of infection within a health care organization requires three elements: a source of infecting microorganisms, a susceptible host, and a means of transmission for the microorganism. The skin of patients and personnel can function as a reservoir for infectious agents and as a vehicle for transfer of infectious agents to susceptible persons. The microbial flora of the skin consists of resident and transient microorganisms. Resident microorganisms persist and multiply on the skin. Transient microorganisms are contaminants that can survive for only a limited period of time. Most resident microorganisms are found in superficial skin layers, but about 10–20% inhabit deep epidermal layers. Handwashing with plain soaps is effective in removing many transient microorganisms. Resident microorganisms in the deep layers may not be removed by handwashing with plain soaps, but usually can be killed or inhibited by antimicrobial products. Handwashing is the single most important measure for preventing nosocomial infections.

Hand-washing indications

Health care workers should wash their hands:

  • after removing gloves
  • when coming on duty
  • when hands are soiled, including after sneezing, coughing, or blowing the nose
  • between patient contacts
  • before medication preparation
  • after personal use of the toilet
  • before performing invasive procedures
  • before taking care of particularly susceptible patients, such as those who are severely immunocompromised and newborns
  • before and after touching wounds
  • before and after eating
  • after touching inanimate objects that are likely to be contaminated with pathogenic microorganisms, such as urine-measuring devices and secretion collection apparatuses
  • after taking care of infected patients or patients who are likely to be colonized with microorganisms of special clinical or epidemiologic significance; for example, bacteria that are resistant to multiple antibiotics

Preparation

Routine hand-washing is accomplished by vigorously rubbing together all surfaces of lathered hands followed by thorough rinsing under a stream of water. This should take 10-15 seconds to complete. The hands should be dried with a paper towel. Immediate recontamination of the hands by touching sink fixtures may be avoided by using a paper towel to turn off faucets.

Universal precautions recommend that all health care workers who come into contact with a patient's blood or body fluids that contain visible blood should wear an appropriate type of barrier to prevent the spread of blood-borne pathogens. Other body fluids for which barrier protection is recommended include semen, vaginal secretions, cerebrospinal fluid (CSF), synovial fluid, pleural fluid, pericardial fluid, and amniotic fluid. The type of exposure determines the specific barrier that should be used. Universal precautions are designed to augment, not replace, standard infection control procedures such as hand washing and the use of gloves when touching obviously infected materials.

Adequate routine cleaning and removal of soil should be the environmental sanitation procedure for all healthcare facilities. Microorganisms are normal contaminants of the environment. A healthcare facility's environmental services department should maintain schedules for routine cleaning in all rooms and include equipment and working surfaces. General and infectious wastes are disposed of on a regular schedule. All departments, though, are responsible for implementing infection control policies.

Complications

Health care workers must not be complacent about implementing their facility's infection control policies. Perhaps due to long time-exposure to occupationally acquired infections, they have the tendency to minimize or ignore the ramifications. Infections oftentimes go undetected, underreported, or overlooked by health care workers.

Results

If infection control programs are successful, the result will be a reduction in the risk of infection and related adverse outcomes in the healthcare setting, achieved in a cost-efficient manner.

Caregiver concerns

Much of the responsibility for infection control rests on the shoulders of the clinical staff providing care at the bedside. Because nurses are close to the patient physically, they are able to prevent the spread of infection, but they can also be a means of transmitting infection. Therefore they need to foster compliance with infection control policies to ensure a high quality outcome for the patient. Infection control practices should have a positive effect on not only the clinical staff, but the patient as well.

Resources

BOOKS

Jennings, J., and F. Manian. APIC Handbook of Infection Control. Washington, D.C.: Association for Professionals in Infection Control and Epidemiology, 1999.

PERIODICALS

Barrs, A. “Infection Control Across the Board.” Nursing Homes Long Term Care Management 49, Issue 11 (November 2000):38.

Henderson, D. “Raising the Bar: The Need for Standardizing the Use of ‘Standard Precautions’ as a Primary Intervention to Prevent Occupational Exposures to Bloodborne Pathogens.” Infection Control and Hospital Epidemiology 22 (February 2001):6.

Heseltine, P. “Why Don't Doctors and Nurses Wash Their Hands?” Infection Control and Hospital Epidemiology 22 (April 2001):4.

Hood, R., and D. Olesen. “Re-evaluating the Role of the Clinical Nurse in Minimizing Health Care Related Infection.” Australian Nursing Journal 8 (October 2000):1.

Rello, J. “Impact of Nosocomial Infections on Outcome: Myths and Evidence.” Infection Control and Hospital Epidemiology 20 (June 1999):6.

“Requirements for Infrastructure and Essential Activities of Infection Control and Epidemiology in Hospitals: A Consensus Panel Report.” Infection Control and Epidemiology 19 (1998):114–124.

Shimkins, J. “Making the Grade.” Health Facilities Management 1 (January 1999):18.

Stratton, C. “Occupationally Acquired Infections: A Timely Reminder.” Infection Control and Hospital Epidemiology (January 2001):22.

ORGANIZATIONS

Hospital Infections Program. Centers for Disease Control and Prevention. 1600 Clifton Road, Atlanta, GA 30333. http://www.cdc.gov/ncidod/publications/brochures/hip.htm.

OTHER

Infection Control: Hand-Washing and Antisepsis. Johns Hopkins University. 2001.

René A. Jackson RN

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Infection Control

Infection control

Definition

Infection control is the protection of patients and health care workers by the prevention of infection in the health care setting in a cost-efficient manner.

Standard precautions for infection control
SOURCE: CDC, 1996.
Environmental controlFollow hospital procedures for routine care, cleaning, and disinfection of all surfaces, beds, bedrails, bedside equipment, and other frequently touched surfaces.
LinenHandle, transport, and process used linen soiled with blood, body fluids, secretions, or excretions in a manner that prevents exposures and contamination of clothing, and avoids transferring microorganisms to other patients and environments.
Occupational health and bloodborne pathogensPrevent injuries when using needles, scalpels, and other sharp instruments or devices; when handling sharp instruments after procedures; when cleaning used instruments; and when disposing of used needles.
Never recap used needles using both hands or any other technique that involves pointing the needle toward any part of the body; instead, use a one-handed "scoop" technique or a mechanical device designed for holding the needle sheath.
Do not remove used needles from disposable syringes by hand, and do not bend, break, or otherwise manipulate used needles by hand. Place used disposable syringes and needles, scalpel blades, and other sharp items in puncture-resistant sharps containers located as close as practical to the area in which the items were used, and place reusable syringes and needles in a puncture-resistant container for transport to the processing area.
Use resuscitation devices as an alternative to mouth-to-mouth resuscitation.
Patient-care equipmentHandle used patient-care equipment soiled with blood, body fluids, secretions, or excretions in a manner that prevents skin and mucous membrane exposures and contamination of other patients and environments. Ensure that reuasable equipment is not used for the care of another patient until it has been appropriately cleaned and reprocessed and single use items are properly discarded.
Patient placementUse a private room for a patient who contaminates the environment or who does not (or cannot be expected to) assist in maintaining appropriate hygiene or environmental control. Consult Infection Control if a private room is not available.
Wash hands (plain soap)Wash after touching blood, body fluids, secretions, excretions, and contaminated items.
Wash immediately after gloves are removed and between patient contacts.
Avoid transfer of microorganisms to other patients or environments.
Wear glovesWear when touching blood, body fluids, secretions, excretions, and contaminated items.
Put on clean gloves just before touching mucous membranes and nonintact skin.
Change gloves btween tasks and procedures on the same patient after contact with material that may contain high concentrations of microorganisms. Remove gloves promptly after use, before touching noncontaminated items and other surfaces, and before going to another patient, and wash hands immediately to avoid transfer of microorganisms to other patients or environments.
Wear gownProtect skin and prevent soiling of clothing during procedures that are likely to generate splashes or sprays of blood, body fluids, secretions, or excretions. Remove a soiled gown as promptly as possible and wash hands to avoid transferring microorganisms to other patients or environments.
Wear mask and eye protection or face shieldProtect mucous membranes of the eyes, nose, and mouth during procedures and patient-care activities that are likely to generate splashes or sprays of blood, body fluids, secretions, or excretions.

Purpose

The purpose of infection control is to reduce the risk of health care worker exposure and infection and nosocomial (hospital-acquired) infections, which can complicate existing diseases or injuries.

Description

Organized efforts at infection control began in the United States in the 1950s, along with the increase in intensive care units to care for critically ill patients and the emergence of nonsocomial staphylococcal infections . Many hospitals implemented programs in the 1960s and 1970s at the insistence of various organizations. In the 1980s, state and federal agencies, along with professional organizations, began to make recommendations for infection control and require adherence to regulations.

Infection control procedures are followed in hospitals, long term care facilities, rehabilitation units, outpatient facilities, and home care . All infection control programs should encourage actions that limit the spread of nosocomial infections. All healthcare institutions are mandated by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) to "develop specific objectives and outcome measures to determine whether or not its infection control goals have been achieved" (AJIC, 1998). Infection control programs must include the means to measure the effectiveness of procedures, policies, or programs to protect patients and health care providers and to determine if these activities are cost-effective.

Health care organizations must be in compliance with regulations and accreditation requirements by various federal and state agencies and governing bodies. JCAHO, for instance, has standards that are incorporated into many state licensing, as well as Medicare and Medicaid , regulations. The facility's administration is responsible for ensuring compliance. Ongoing education and training are an important part of an effective infection control program. Also, the monitoring of patient-care activities can identify areas of concern, and the data obtained is vital to improving the program and ensuring successes.

The Hospital Infections Program (HIP) of the National Center for Infectious Diseases, Centers for Disease Control and Prevention (CDC), is the focus for information, surveillance, investigation, prevention, and control of nosocomial infections for the U.S. Public Health Service, state and local health departments, hospitals, and professional organizations in the United States and around the world. Studies indicate that one-third of nosocomial infections can be prevented by well-organized infection control programs, yet only 6-9% are actually prevented. The Study of Efficacy of Nosocomial Infection Control (SENIC) carried out by HIP over ten years showed that, to be effective, nosocomial infection programs must include the following: 1) organized surveillance and control activities, 2) a ratio of one infection control practitioner for every 250 acute care beds, 3) a trained hospital epidemiologist, and 4) a system for reporting surgical wound infection rates back to surgeons (NNIS, 1996). The National Nosocomial Infections Surveillance (NNIS) System has been gathering information for 20 years regarding nosocomial infections. This information is being used to assist hospitals in conducting successful surveillance of these infections.

In 1987, the Centers for Disease Control (CDC) expanded previous recommendations to prevent the spread of human immunodeficiency virus (HIV), hepatitis B virus (HBV), and other bloodborne pathogens. Previously, certain isolation precautions were recommended only for those patients who were known or suspected to have bloodborne infectious diseases. Because of the growing number of persons infected with HIV and the high mortality rates associated with AIDS , Universal Blood and Body Fluids Precautions were developed. Under these new recommendations, all patients are considered potentially infectious for bloodborne infections. In 1991, the Occupational Safety and Health Administration's (OSHA) Bloodborne Pathogen Standard required the use of universal precautions and dictated that all staff must be trained annually on the risk of exposure to bloodborne pathogens. Preventing exposure is the best and safest way to reduce infection.

The effectiveness of infection control programs are evaluated in several ways: lower rates of infection for the patient, shorter periods of hospital stays, decreased morbidity, and reduction of on-the-job exposure of health

Methods of disinfection
Method Use
SOURCE: Benarde, M.A., ed. Disinfection: A Treatise. New York: Marcel Dekker, 1970.
AlcoholsSkin degerming.
AutoclavingSterilize instruments not harmed by heat and water pressure.
Boiling waterKill non-spore-forming pathogenic organisms.
ChlorinesWater disinfection; food surface sanitization.
Ethylene oxide gasSterilization of heat-sensitive materials or those that must be kept dry.
Fiberglass filtersAir disinfection.
Formaldehyde (formalin)Drastic disinfection.
Formaldehyde gasFumigation; sterilization of heat-sensitive materials.
Germicidal soaps (hexachlorophene)Skin degerming.
Iodines, tinctureSkin degerming.
Iodines, iodophorsGeneral disinfectant.
IonizingSterilize medicines, some plastics, sutures, and biologicals.
Membrane filtrationWater purification.
MercurialsSkin degerming.
PhenolsGeneral disinfectant.
Quaternary ammonia compounds, tinctureSkin degerming.
Quaternary ammonia compounds, aqueousGeneral disinfectant.
UltrasonicDisinfect instruments.
Ultraviolet lightAir and surface disinfection.
WashingDisinfect hands and surfaces.

care workers to infection and contamination from patients. To do this, infection control policies focus on strategies for isolation, barrier precautions, case investigation, health care worker education, immunization services, and employee health programs. When healthcare institutions are successful in their infection control programs, it decreases the cost of care and has a positive impact on the institution's image within the community.

It is the responsibility of infection control to identify problems, collect and analyze data, change policies and procedures when necessary, and monitor data. The specific functions of an infection control program should be based on the needs of the individual healthcare institution. It is most important to monitor infection activity. Data is collected and disseminated based on the principles of epidemiology to implement quality-improvement activities and improve patient outcomes. Policies and procedures of the facility must be based on scientific and valid infection control prevention and be reviewed and updated frequently to reflect practice guidelines and standards.

SELECTED INFECTIOUS DISEASES AND CORRESPONDING TREATMENT
Disease Symptoms Transmittal Treatment
Chicken poxRash, low-grade feverPerson to personNone
Common cold/InfluenzaRunny nose, sore throat, cough, fever, headache, muscle achesPerson to personNone
HepatitisJaundice, flu-like symptomsSexual contact with an infected person, contaminated blood, food, or waterNone
Legionnaire's DiseaseFlu symptoms, pneumonia, diarrhea, vomiting, kidney failure, respiratory failureAir conditioning or water systemsAntibiotics
MeaslesSkin rash, runny nose and eyes, fever, coughPerson to personNone
MeningitisNeck pain, headache, pain caused by exposure to light, fever, nausea, drowsinessPerson to personAntibiotics for bacterial meningitis, hospital care for viral meningitis
MumpsSwelling of salivary glandsPerson to personAnti-inflammatory drugs
RingwormSkin rashContact with infected animal or personAntifungal drugs applied topically
TetanusLockjaw, other spasmsSoil infection of woundsAntibiotics, antitoxins, muscle relaxers

(Public Domain.)

Transmission of infection within a health care organization requires three elements: a source of infecting microorganisms, a susceptible host, and a means of transmission for the microorganism. The skin of patients and personnel can function as a reservoir for infectious agents and as a vehicle for transfer of infectious agents to susceptible persons. The microbial flora of the skin consists of resident and transient microorganisms. Resident microorganisms persist and multiply on the skin. Transient microorganisms are contaminants that can survive for only a limited period of time. Most resident microorganisms are found in superficial skin layers, but about 10-20% inhabit deep epidermal layers. Handwashing with plain soaps is effective in removing many transient microorganisms. Resident microorganisms in the deep layers may not be removed by hand-washing with plain soaps, but usually can be killed or inhibited by antimicrobial products. Handwashing is the single most important measure for preventing nosocomial infections.

Hand-washing indications

Health care workers should wash their hands:

  • after removing gloves
  • when coming on duty
  • when hands are soiled, including after sneezing, coughing, or blowing the nose
  • between patient contacts
  • before medication preparation
  • after personal use of the toilet
  • before performing invasive procedures
  • before taking care of particularly susceptible patients, such as those who are severely immunocompromised and newborns
  • before and after touching wounds
  • before and after eating
  • after touching inanimate objects that are likely to be contaminated with pathogenic microorganisms, such as urine-measuring devices and secretion collection apparatuses
  • after taking care of infected patients or patients who are likely to be colonized with microorganisms of special clinical or epidemiologic significance; for example, bacteria that are resistant to multiple antibiotics

Preparation

Routine hand-washing is accomplished by vigorously rubbing together all surfaces of lathered hands followed by thorough rinsing under a stream of water. This should take 10-15 seconds to complete. The hands should be dried with a paper towel. Immediate recontamination of the hands by touching sink fixtures may be avoided by using a paper towel to turn off faucets.

Universal precautions recommend that all health care workers who come into contact with a patient's blood or body fluids that contain visible blood should wear an appropriate type of barrier to prevent the spread of blood-borne pathogens. Other body fluids for which barrier protection is recommended include semen, vaginal secretions, cerebrospinal fluid (CSF), synovial fluid, pleural fluid, pericardial fluid, and amniotic fluid. The type of exposure determines the specific barrier that should be used. Universal precautions are designed to augment, not replace, standard infection control procedures such as hand washing and the use of gloves when touching obviously infected materials.

Adequate routine cleaning and removal of soil should be the environmental sanitation procedure for all healthcare facilities. Microorganisms are normal contaminants of the environment. A healthcare facility's environmental services department should maintain schedules for routine cleaning in all rooms and include equipment and working surfaces. General and infectious wastes are disposed of on a regular schedule. All departments, though, are responsible for implementing infection control policies.

Complications

Health care workers must not be complacent about implementing their facility's infection control policies. Perhaps due to long-time exposure to occupationally acquired infections, they have the tendency to minimize or ignore the ramifications. Infections oftentimes go undetected, underreported, or overlooked by health care workers.

Results

If infection control programs are successful, the result will be a reduction in the risk of infection and related adverse outcomes in the healthcare setting, achieved in a cost-efficient manner.

Health care team roles

Much of the responsibility for infection control rests on the shoulders of the clinical staff providing care at the bedside. Because nurses are close to the patient physically, they are able to prevent the spread of infection, but they can also be a means of transmitting infection. Therefore they need to foster compliance with infection control policies to ensure a high quality outcome for the patient. Infection control practices should have a positive effect on not only the clinical staff, but the patient as well.

Resources

BOOKS

Jennings, J., and F. Manian. APIC Handbook of Infection Control. Washington, D.C.: Association for Professionals in Infection Control and Epidemiology, 1999.

PERIODICALS

Barrs, A. "Infection Control Across the Board." Nursing Homes Long Term Care Management 49, Issue 11 (November 2000):38.

Henderson, D. "Raising the Bar: The Need for Standardizing the Use of "Standard Precautions" as a Primary Intervention to Prevent Occupational Exposures to Bloodborne Pathogens." Infection Control and Hospital Epidemiology 22 (February 2001):6.

Heseltine, P. "Why Don't Doctors and Nurses Wash Their Hands?" Infection Control and Hospital Epidemiology 22 (April 2001):4.

Hood, R., and D. Olesen. "Re-evaluating the Role of the Clinical Nurse in Minimizing Health Care Related Infection." Australian Nursing Journal (8 October 2000):1.

Rello, J. "Impact of Nosocomial Infections on Outcome: Myths and Evidence." Infection Control and Hospital Epidemiology 20 (June 1999):6.

"Requirements For Infrastructure and Essential Activities of Infection Control and Epidemiology in Hospitals: A Consensus Panel Report." Infection Control and Epidemiology 19 (1998):114-124.

Shimkins, J. "Making the Grade." Health Facilities Management 1 (January 1999):18.

Stratton, C. "Occupationally Acquired Infections: A Timely Reminder." Infection Control and Hospital Epidemiology (January 2001):22.

ORGANIZATIONS

Hospital Infections Program. Center for Disease Control and Prevention. 1600 Clifton Road, Atlanta, GA 30333. <http://www.cdc.gov/ncidod/publications/brochures/hip.htm>.

OTHER

Infection Control: Hand-Washing and Antisepsis. Johns Hopkins University. 2001.

René A. Jackson, RN

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"Infection Control." Gale Encyclopedia of Nursing and Allied Health. . Retrieved September 10, 2018 from Encyclopedia.com: http://www.encyclopedia.com/medicine/encyclopedias-almanacs-transcripts-and-maps/infection-control-1

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