NCLEX-RN: Infection Control

Infection Control: AIDS

Focus topic: Infection Control

 

Definition: The most severe form of a continuum of illnesses associated with human immunodeficiency virus (HIV) infection.

Infection Control: Characteristics

Focus topic: Infection Control
A. Normal versus AIDS immune response.

  • In the normal immune system, killer/ suppressor and helper/inducer T cells are evenly distributed.
  • AIDS clients show an acquired defect of
    immunity.
    a. Helper T cells are depleted, which causes a reversal of normal ratio of helper/inducer to killer/suppressor T cells.
    b. Client cannot activate effective immune response either to foreign invaders or to cancer cells.
    c. This deficiency leads to the majority of signs and symptoms observed in AIDS clients.

B. HIV is a bloodborne retrovirus and has a different life cycle from a normal virus.

  • Genetic information is usually sequenced by DNA being transcribed into RNA, which is then translated into proteins necessary for life.
  • Retroviruses reverse the sequence: RNA code is transcribed backward into DNA and may be integrated into host cell chromosomes.
  • This retrovirus invades CD4+ T-lymphocyte (immunity) cells, renders them useless, and then duplicates itself (which affects client’s immune function so that the disease becomes clinically manifested).
  • HIV attaches and changes the protein on the surface of the helper T cells.

C. Transmission of the HIV virus.

  • HIV does not appear to be highly contagious.
  • Transfer of the virus occurs through a transfer of body fluids, either from mother to child during perinatal period or through intimate sexual contact or parenteral exposure. Fluids with HIV transmission potential of the disease are: semen, blood, breast milk, vaginal/cervical secretions.
  • Body fluids containing infected lymphocytes must enter the bloodstream or body cavity to spread the virus.
  • The virus exists in tears, saliva, urine, feces, spinal fluid, sputum, pus, and bone marrow; epidemiological evidence has not confirmed transmission through these body fluids.
    a. High concentrations of HIV found in blood, semen, and cerebrospinal fluid.
    b. Lower concentrations of HIV found in urine, vaginal secretions, saliva, feces, breast milk.

D. HIV statistics.

  • More than 1.1 million Americans are living with HIV—47,500 new infections occur each year.
  • Two major risk groups continue to be homosexual or bisexual men (accounting for 47.9% of AIDS cases) and IV drug abusers (which make up 85% of all AIDS cases).

E. Opportunistic conditions: disease processes that occur as a result of suppressed immune system.

  • Pneumocystis jiroveci: a parasitic infection of the lungs. One of the two rare diseases that affect 85% of AIDS clients; similar to other types of pneumonia.
  • Kaposi sarcoma: a type of cancer usually occurring on the surface of the skin or in the mouth. This disease may also spread to internal organs.
  • Dementia with AIDS virus: a clinical syndrome in which there is acquired persistent intellectual impairment, in this case caused by the HIV virus.
Infection Control

Infection Control: Assessment

Focus topic: Infection Control

A. Assess for chronic fatigue, diarrhea, skin breakdown, fever, dehydration, and neurologic symptoms.
B. Assess physical status for degree of independence.

  • Ability to be mobile without assistance.
  • Amount of medication that interferes with alertness.

Infection Control: Implementation

Focus topic: Infection Control

A. New therapies have extended the life span of AIDS clients.

  • Trends of both AIDS cases and deaths are declining.
  • Decrease is thought to be related to prevention efforts targeted at high-risk populations and new medications.

B. More than 20 antiretroviral drugs have been approved by the FDA.
C. CDC recommends aggressive antiretroviral therapy (ART)—viral suppression is the goal.

  • HAART (highly active antiretroviral therapy)—one protease inhibitor and two nonnucleoside reverse transcriptase inhibitors are
    recommended.
  • According to WHO, by the end of 2012, 9.7 million people were on ART.
  • The impact of ART in 2012 was that 4.2 million deaths were averted.

D. HIV death rate has dropped by 85% since its peak. This is due to ART and decreased HIV incidence after the 1980s.

Infection Control: Healthcare Workers’ Exposure to HIV

Focus topic: Infection Control

A. The Public Health Service updated recommendations for management of healthcare workers’ exposure to HIV. The decision to recommend HIV post-exposure prophylaxis (PEP) takes into account two factors:

  • The nature of the exposure.
  • The amount of blood or body fluid involved in the exposure.

B. Healthcare facilities should have the protocols available and mandate prompt reporting and post-exposure care.

  • Healthcare workers must be educated to report occupational exposures immediately after they occur.
  • PEP is most likely to be effective if implemented as soon after the exposure as possible.
  • Exposure is defined as a percutaneous injury, contact of mucous membrane or nonintact skin, or contact with intact skin when the duration of contact is prolonged.
  • Risk assessment is performed on all healthcare workers who have been exposed to potentially HIV-infected blood or body fluids.
  • The FDA has recently approved a pointof-care HIV test that provides results in 5 minutes. If positive, a follow-up confirmation test must be done.
  • Goal is to balance risk for infection against potential toxicity of the PEP drugs.

C. Recommendations for PEP:

  • A basic 4-week regimen of two drugs (zidovudine and lamivudine) is appropriate for most HIV exposures.
  • Expanded regimen that includes the addition of a protease inhibitor (indinavir or nelfinavir) is recommended for increased risk for transmission of HIV exposures.
  • There is now available a boosted protease inhibitor (Kaletra) that helps to reduce the viral load.

Infection Control: HIV–HBV Healthcare Worker Alert

Focus topic: Infection Control

A. Accidental contact with blood or body fluids.

  • Any percutaneous or mucocutaneous exposure should receive immediate first aid.
    a. Percutaneous exposure—a break in the skin caused by contaminated needle or sharp instrument, broken glass container holding blood or body fluids, or human bite.
    b. Mucocutaneous exposure—body fluid contact to open wounds, nonintact skin (eczema), or body fluid splash to mucous membranes (mouth, eyes).
  • Apply immediate first aid to site.
  • a. Needlestick or puncture wound: Scrub area vigorously with soap and water for 5 minutes.
    b. Oral mucous membrane exposure: Rinse area several times with water.
    c. Ocular exposure: Irrigate immediately with water or normal saline solution.
    d. Human bite: Cleanse wound with Betadine (povidone–iodine) and sterile water.
  • Report unusual occurrence to the charge nurse or supervisor.
  • Complete an unusual occurrence form and follow reporting requirements mandated by OSHA.

B. Health Care Worker Protection Act.

  • The Health Care Worker Protection Act was passed to reduce number of healthcare workers who are accidentally exposed to potentially contaminated, infected blood via a needlestick.
    a. More than 600,000 needle sticks and injuries are reported yearly.
    b. Most common cause of exposure to blood borne pathogens is needle stick injuries with post-injury risk for HIV exposure.
  • This act makes the use of safe needle devices a requirement if facility receives Medicare funding.
  • More than 20 pathogens can be transmitted through small amounts of blood.
    a. Hepatitis B is the most common infectious disease transmitted through work-related exposure to blood and needle sticks.
    b. In addition to HIV and hepatitis B, syphilis, varicella-zoster, and hepatitis C can be transmitted via this route.

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