Risk for Infection and Infection Control Nursing Care Plan and Management

Enhance your nursing proficiency with this extensive nursing care plan and management resource, meticulously crafted to assist nurses in delivering optimal care to patients at risk of infection. Develop a thorough grasp of nursing assessments, evidence-based interventions, achievable goals, and nursing diagnoses customized for infection prevention and control. By leveraging this guide, nurses can refine their abilities in identifying, preventing, and effectively managing infections.

What is the risk for infection and infection control?

Infections arise when an individual’s natural defense mechanisms prove insufficient to safeguard them. Microorganisms, including bacteria, viruses, fungi, and other parasites, infiltrate vulnerable hosts through inevitable injuries and exposures. The body possesses specialized cells and tissues collectively known as the immune system to combat these threats.

The human immune system plays a pivotal role in survival within a world teeming with potentially harmful microbes. Severe impairment of this system increases susceptibility to serious, and sometimes life-threatening, infections. Key organs and tissues integral to the immune system comprise the thymus, bone marrow, lymph nodes, spleen, appendix, tonsils, and Peyer’s patches (located in the small intestine). When the immune system fails to adequately counter the invading microorganism, an infection ensues.

Breaks in the integrity of the skin, mucous membranes, soft tissues, or even internal organs like the kidneys and lungs can serve as potential sites for infections following trauma, invasive procedures, or the infiltration of pathogens through the bloodstream or lymphatic system. A sequence of events must unfold for an infection to take hold, involving six essential elements: a causative organism, a reservoir, a mode of transmission from the reservoir to the host, and a mode of entry into a susceptible host.

It’s crucial to distinguish between infection and infectious disease. Infectious disease is the condition in which the infected host experiences a decline in well-being due to the infection. If the host interacts immunologically with an organism but remains symptom-free, the criteria for infectious disease are not met.

Common means of infectious disease transmission include direct transfer of bacteria, viruses, or other germs from one person to another through contact, airborne transmission, sexual contact, or sharing of IV drug paraphernalia. Inadequate resources, lack of knowledge, and malnutrition elevate the risk of infection.

Infections can impede the healing process and, if left untreated, may lead to death. Antimicrobials are frequently employed for treating infections when susceptibility is present, although some organisms, like the human immunodeficiency virus (HIV), may not respond to antimicrobials. Immunization is a prevalent medical intervention, especially for those at high risk of infection. Handwashing remains the most effective method for breaking the chain of infection.

In the realm of healthcare, infection control entails the policies and procedures implemented to manage and minimize the spread of infections in hospitals and other healthcare settings, aiming to reduce infection rates. Originally, infection control programs primarily focused on surveilling hospital-associated infections (HAIs) and incorporating epidemiological insights to identify risk factors for HAIs (Lungu, 2023).

Tailoring specific nursing interventions depends on the nature and severity of the risk. Nurses play a vital role in informing and educating clients on recognizing signs of infection and implementing measures to reduce their risk.

Causes of infection

Numerous health issues and conditions can create a conducive environment that fosters the development of infections. The following are common causes of infection and factors that elevate a client’s risk for infection.

Insufficient primary defenses: These constitute the body’s initial line of defense against infection and encompass the skin, mucous membranes, and normal flora. Examples of inadequate primary defenses include:

A breach in the skin, like a cut or wound
Tissue damage resulting from burns or frostbite
Dry skin
Dehydrated mucous membranes lacking moisture
Absence of normal flora, as induced by antibiotics.

Lack of knowledge to prevent exposure to pathogens: This refers to a deficit in understanding how to avert infections. Examples of inadequate knowledge to avoid exposure to pathogens include:

Lack of awareness on proper handwashing techniques
Insufficient knowledge on preventing the dissemination of germs
Unfamiliarity with proper cleaning and disinfection practices for surfaces
Limited understanding of safe food handling procedures.

Weakened host defenses: This constitutes the body’s secondary defense against infection, encompassing the immune system, white blood cells, and the inflammatory response. Examples of compromised host defenses include:

Cancer
Immunosuppression
Acquired Immunodeficiency Syndrome (AIDS)
Diabetes mellitus
Malnutrition
Chronic conditions like heart disease, lung disease, and kidney disease
Medications such as chemotherapy and steroids.

Impaired circulation: This refers to a reduction in blood flow to the tissues. Examples of compromised circulation include:

Obesity
Lymphedema
Peripheral vascular disease
Smoking
Diabetes mellitus.

Entry point for pathogen invasion: This denotes an opening in the body that permits pathogens to enter. Examples of a site for organism invasion include:

A post-surgical incision
A burn
A breach in the skin
A urinary tract infection
A respiratory infection
A central venous line
An enteral feeding tube.

Exposure to infectious agents: This entails encountering pathogens capable of causing infection. Examples of contact with contagious agents include:

Being in proximity to an individual who is unwell
Touching contaminated surfaces
Failing to cover your mouth when coughing or sneezing.

Elevated susceptibility of the infant: This refers to a condition that renders an infant more prone to infection. Examples of increased vulnerability in infants include:

Premature birth
Low birth weight
Congenital heart defect
Cleft lip or palate
Compromised immune system.

Persistent health conditions: These are enduring medical conditions that have the potential to compromise the immune system. Examples of chronic diseases include:

Cardiovascular disease
Respiratory disease
Renal disease
Diabetes mellitus
Engaging in sexual activity with multiple partners without practicing safe sex can elevate the risk of infection.
Failure to undergo immunization leaves individuals susceptible to infections, potentially increasing the severity of the disease when contracted.

Development and Execution of Nursing Care Plans

Nursing care plans for infections center on thorough assessment, early identification, timely intervention, and education for both clients and healthcare providers. These plans strive to reduce the likelihood of healthcare-associated infections and enhance the overall health of clients across diverse healthcare settings, encompassing hospitals, long-term care facilities, clinics, and home care.

Nursing Priorities for Clients at Risk for Infection:

Priorities in Nursing for Infection Management:

Infection Control and Prevention: Nurses must prioritize the implementation of infection prevention measures to minimize the risk of infection spread.
Assessment and Early Detection: Early identification of infections is crucial for prompt intervention. Timely detection allows for the implementation of appropriate treatment measures.
Isolation Precautions: Isolation precautions ensure that clients are placed in the appropriate type of isolation based on the mode of transmission and employ necessary barriers to ensure safety.
Surgical Asepsis: Rigorous adherence to the principles of surgical asepsis is fundamental to preventing surgical site infections.
Client and Caregiver Education: Educating clients and caregivers increases awareness and understanding of infection prevention strategies, thereby reducing the risk of infection.

Nursing Assessment:

The signs and symptoms of infection can vary, contingent on the type and location of the infection, as well as the client’s immune response.

Assess for the following subjective and objective data:

Fever: An elevated body temperature may be accompanied by chills and sweating.
Pain or Tenderness: Infections can induce localized pain or tenderness at the site of infection.
Redness and Swelling: Inflammation, characterized by redness, warmth, and swelling, is a hallmark of infection.
Tachycardia and Tachypnea: Infections may lead to an increase in heart rate and respiratory rate as the body mobilizes to combat pathogens.
Malaise: A general sense of discomfort, uneasiness, or feeling unwell.
Increased White Blood Cell Count: In response to infection, the body may produce more white blood cells, resulting in an elevated white blood cell count.

Nursing Diagnosis:

The risk of infection is identified when there is potential for the client to develop an infection due to various factors or circumstances. This diagnosis is established through a comprehensive assessment of the client’s health history and risk factors that may compromise the immune system. Nurses must apply their expertise to pinpoint specific risk factors and collaborate with other healthcare professionals to devise targeted interventions aimed at preventing the occurrence of infections.

Nursing Aims

The client will remain free of infection, as demonstrated by normal vital signs and the absence of signs and symptoms of infection.
The client will maintain or restore defenses against infection.
Early recognition of infection to facilitate prompt treatment.
The client will demonstrate proficient hand-washing technique.
Alleviate or reduce problems associated with the infection.

Nursing Interventions and Actions:

Conducting a thorough assessment is crucial for identifying factors that may contribute to infection. Utilize the nursing assessment guidelines below to pinpoint subjective and objective data for the risk-for-infection care plan:

Conducting Assessment and Early Detection:

Recognizing an infection in its initial stages allows healthcare professionals to prescribe appropriate antimicrobial agents or interventions targeting the specific pathogen causing the infection.
Assess for the presence, existence, and history of common infection causes (as listed above).
These factors indicate a breach in the body’s normal first line of defense and may signal an infection. Microorganisms responsible for infections encompass bacteria, rickettsiae, viruses, protozoa, fungi, and helminths.
Assess for the presence of local infectious processes in the skin or mucous membranes. Indications include localized swelling, redness, pain or tenderness, loss of function in the affected area, and palpable heat. A client colonized with S. aureus may harbor staphylococci on the skin without evident irritation. However, if there is an incision, S. aureus could enter the wound, triggering an immune response with local inflammation and the migration of white cells to the site.

Monitor and report any signs and symptoms of infection:

Signs and symptoms of infection can vary depending on the body area involved. Assess for the following signs and symptoms:

Redness, swelling, increased pain, or purulent discharge from incisions, injuries, and exit sites of tubes (IV tubings), drains, or catheters. These are classic signs of infection. Suspicious drainage should be cultured, and antibiotic therapy is determined by the identified pathogens. Approximately 20% of clients may be colonized immediately at the time of catheter insertion, as bacteria can ascend through the catheter lumen via the reflux of urine from contaminated bags or from the urethra (Chinyama,2020).
Elevated temperature: Fever is often the initial sign of an infection. A temperature of up to 38º C (100.4º F) within 48 hours post-op is usually related to surgical stress. A temperature greater than 37.7º C (99.8º F) may indicate infection, and a very high temperature accompanied by sweating and chills may suggest septicemia. In a prospective study of older adult clients, it was demonstrated that a tympanic body temperature higher than 37.3º C (99.14º F) and a rectal body temperature higher than 37.8º C (100.4º F) are reliable markers of bacterial infection (Kaunda, 2020).
Color of respiratory secretions: Yellow or yellow-green sputum is indicative of respiratory infection. Neutrophils, a type of white blood cell, have a green color, and their presence in sputum suggests bacterial infections in the lower respiratory tract, such as pneumonia (Eldridge, 2023).
Appearance of urine: Cloudy, turbid, foul-smelling urine with visible sediment indicates a urinary tract or bladder infection. However, recent reports suggest that visual inspection of urine may not be conclusive. Cloudiness of urine is often due to the presence of protein or crystals, and malodorous urine may result from diet or medication use. In these cases, urine cultures should be obtained (Albert, 2022).

Monitor White Blood Cell (WBC) Count.

Observing the WBC count is essential as an increasing count signals the body’s defensive response against pathogens, known as leukocytosis, primarily involving neutrophils. This is often an indicator of an inflammatory response such as infection but can also occur in parasitic infections or cancers like leukemia (Rowe, 2022). WBC count categories are as follows:

Low: Below 4,500
Normal: 4,500 – 11,000
High: More than 11,000

A significantly low WBC count may suggest a severe risk of infection. In older adult clients, infection may be present without a notable increase in WBC count. Furthermore, a WBC differential may reveal fluctuations in specific infections.

Assess and monitor nutritional status, weight, history of weight loss, and serum albumin. Clients with inadequate nutrition may exhibit an inability to mount a cellular immune response to pathogens, rendering them susceptible to infections. Deficiencies or suboptimal levels in micronutrients can adversely affect immune function and decrease resistance to infections. Vitamin D deficiency has been associated with an increased risk of respiratory infections (Calder et al., 2020).
Investigate the use of medications or treatment modalities that may cause immunosuppression: Antineoplastic agents, corticosteroids, and similar medications can suppress immune function. Corticosteroids and tumor necrosis factor inhibitors are examples of medications that can heighten the risk of fungal infections (Centers for Disease Control and Prevention, 2020). Immunosuppressant’s are a class of medicines that inhibit or decrease the intensity of the immune response in the body (Hussain & Khan, 2022).
Assess immunization status and history: People with incomplete immunizations may lack sufficient acquired active immunity. The nurse may inquire about clients’ immunization history during assessment. Risks and benefits, considering factors such as morbidity, mortality, and financial cost, must be evaluated for both the individual and the community. Successful vaccine programs have substantially reduced the incidence of many infectious diseases.
Observe and report if an older adult client has a low-grade fever or new onset of confusion: Low-grade temperature elevation in older clients should be promptly reported as it may indicate a potential infection. Older adults often manifest a non-specific decline from their baseline functional status. Cognitive impairment can contribute to atypical presentations of infections, further limiting their ability to communicate symptoms. Fever may be absent in 30 to 50% of frail older adults, even in cases of serious infections (Debonera & Simmons, 2021).
Obtain a travel history from clients: Incorporating travel history into the assessment can aid in identifying possible outbreaks and contextualizing infectious symptoms for the healthcare team. As many as 43 to 79% of travelers to low- and middle-income countries experience travel-associated health issues. Most post-travel infections become evident shortly after returning, but incubation periods vary, and some syndromes may present months to years after initial infection or travel (Fairley, 2023).
Determine the client’s travel exposures: Understanding the client’s exposures during travel, such as consumption of contaminated food or water, insect bites, and freshwater swimming, can assist in the differential diagnosis. Accommodations and activities can also influence the risk of acquiring specific diseases while abroad. Travelers who visit friends and relatives face a higher risk for malaria, typhoid fever, and other diseases, often due to longer stays, travel to remote destinations, increased contact with local water sources, and a tendency to avoid seeking pre-travel advice (Fairley, 2023).
For pregnant clients, assess the intactness of amniotic membranes: Prolonged rupture of amniotic membranes before delivery increases the risk of infection for both the mother and neonate. Many pregnant clients with infections may be asymptomatic, emphasizing the need for clinical awareness and thorough screening (Smith, 2023).
Perform screening of pregnant women at 35 to 37 weeks of gestation: At 35 to 37 weeks of gestation, all pregnant women should undergo screening with a vaginal or rectal swab for culture. The most specific site for culture is at the introitus, just inside the hymenal ring and rectally beyond the sphincter. This screening may reveal the presence of group B streptococcus, the most common cause of life-threatening infections in newborns (Smith, 2023).
Identify factors that can diminish the effectiveness of hand hygiene. The condition of the hands can impact the efficacy of hand hygiene. Skin cracks, dermatitis, or cuts can trap bacteria, increasing the risk for clients. Rings and bracelets can elevate microbial counts on hands. In cases where a bracelet cannot be removed for religious reasons, it may be pushed as high as possible above the wrist before performing hand hygiene (McCutcheon & Doyle, 2015).
Assess for a history of latex allergy. Latex allergy is a reaction to proteins in natural rubber latex. Contact with latex can trigger an allergic reaction. It is noteworthy that powdered latex gloves have been associated with latex allergies. Individuals at risk for latex allergy include healthcare workers frequently using latex gloves, clients with a history of multiple surgeries, those regularly exposed to natural rubber latex, and individuals with other allergies, such as allergic rhinitis or food allergies (McCutcheon & Doyle, 2015).
Conduct a prompt risk assessment for blood and body fluid exposure following an incident. A risk assessment for blood and body fluid exposure should be completed within two hours of an incident. Healthcare workers may undergo this assessment at the emergency department or an urgent care center, evaluated by a healthcare provider. The assessment considers the exposure risk and transmission risk from the source (McCutcheon & Doyle, 2015).
Monitor C-reactive protein (CRP) levels. CRP serves as another marker of inflammation, rising approximately six hours after infection, peaking at 48 hours, with a half-life of 19 hours, and being influenced by immunosenescence but not by comorbidities. It can be utilized for therapeutic monitoring (Debonera & Simmons, 2021).
Employ validated and reliable biomarkers for predicting infection in older adults. As the aging population continues to grow, there is a recognized need for further investigation into prognostic modeling. The CURB-65 score, incorporating confusion, uremia, a respiratory rate of 30 breaths per minute, low blood pressure, and age 65 years or older, has been validated for older adults. This score serves as an indicator of mortality and helps determine the appropriate care setting for the client. Additionally, the Pneumonia Severity Index (PSI) is widely utilized to stratify the risk of clients with Community-Acquired Pneumonia (CAP), aiding in the decision of whether clients can be managed as inpatients or outpatients (Debonera & Simmons, 2021).

Infection Control and Prevention

The primary goal of infection control is to prevent and minimize the risk of hospital-acquired infections. This is accomplished through the implementation of infection control programs, including surveillance, isolation, outbreak management, environmental hygiene, education, and the establishment of infection prevention policies and management (Habbas, 2023).
Maintain strict asepsis during dressing changes, wound care, intravenous therapy, and catheter handling.
Utilizing aseptic techniques reduces the likelihood of transmitting or spreading pathogens among clients. Adhering to a meticulous aseptic technique during catheter insertion, employing pre-assembled sterile closed urinary drainage systems with the smallest catheter size possible, effectively interrupts the chain of infection (refer to the image above) and prevents infection spread. Given the elevated infection risk in open wounds, maintaining aseptic conditions during dressing changes and wound care is crucial.
Wash hands or practice hand hygiene before any contact with the client. Additionally, educate clients and their significant others on hand hygiene practices, emphasizing the “5 moments for hand hygiene”:
Before touching a client.
Before performing a cleaning or aseptic procedure (e.g., wound dressing, starting an IV, etc.).
After direct contact with body fluids.
After touching a client.
After touching the client’s surroundings.

Friction and running water are effective in removing microorganisms from hands: Washing hands between procedures is essential for minimizing the risk of transmitting pathogens from one body area to another. To ensure thorough hand hygiene, use antiseptic soap and water for a minimum of 15 seconds, followed by an alcohol-based hand rub. If hands have not come into contact with anyone or anything in the room, or if they are not visibly dirty, opt for an alcohol-based hand rub and continue rubbing until dry. While plain soap reduces bacterial counts, antimicrobial soap provides better results, and alcohol-based hand rubs are considered the most effective (Gilmartin, 2019).

Promote the consumption of protein-rich and calorie-rich foods and advocate for a balanced diet: Ensuring proper nutrition and a balanced diet is crucial for supporting the immune system’s responsiveness and overall health of the body’s tissues. Adequate nutrition plays a key role in maintaining and rebuilding tissues, contributing to optimal immune system function. Nutrition interventions show promise in mitigating the negative impact of aging on immune function, enhancing resistance to infections in the older adult population. Key nutrients such as zinc, vitamin E, and vitamin D have been identified as significant contributors (Pae, 2017).
Change dressings and bandages that are soiled or wet: When cleansing the skin, an aseptic technique is employed, and dressings are changed as prescribed by the surgeon, typically between the second and fifth postoperative days for postsurgical wounds. However, if a dressing shows visible soiling, it is recommended to change it after consulting with the healthcare provider.
Assist clients in practicing appropriate skin hygiene: Frequent cleansing of the skin, particularly the hands, offers a simple, cost-effective, widely adopted, and effective strategy to prevent self-inoculation, reducing the transfer of viruses to mucous membranes in the nose, mouth, and eyes (Rivers. 2021).
Dispose of soiled linens properly: Soiled linens, especially those contaminated with bodily fluids, may harbor pathogens like bacteria, viruses, and fungi. Proper disposal is essential to prevent the spread of these microorganisms, reducing the risk of infection for both healthcare providers and clients.
Avoid talking, coughing, or sneezing over open wounds or sterile fields: Respiratory infections are highly virulent and easily transmitted in populations. These pathogens can be aerosolized and are highly contagious. Maintaining proper respiratory hygiene is crucial for a healthy environment, starting with individuals recognizing their symptoms and practicing appropriate respiratory hygiene (DePaola, 2019).
Wear gloves when handling the client’s body fluids: Gloves serve as an effective barrier for hands against microflora associated with client care. They should be worn during any contact with client secretions or excretions and discarded after each client care interaction. Following glove removal, hands should be washed, as microbial organisms on the hands can proliferate in the warm, moist environment provided by gloves.
Instruct clients to practice hand hygiene when handling food or eating: Hand transmission is a common cause of bacterial spread in healthcare settings. Effective handwashing requires at least 15 seconds of vigorous scrubbing, paying special attention to the areas around nail beds and between fingers, where bacterial load is higher.
Encourage increased fluid intake unless contraindicated (e.g., heart failure, kidney failure). Increased fluid intake promotes diluted urine, frequent bladder emptying, and reduced urine stasis, decreasing the risk of bladder or urinary tract infections. Adequate fluid intake helps replace fluids lost during fever and thins secretions. Proper hydration also helps maintain the moisture balance of the skin and tissues, preventing dry, cracked skin that could serve as entry points for pathogens, thereby reducing the risk of infection.
Encourage coughing and deep breathing exercises, as well as frequent position changes. These practices help prevent the stasis of secretions in the lungs and bronchial tree. Stagnant secretions may lead to microbial infection in the respiratory tract, potentially resulting in pneumonia. Chest physiotherapy, involving techniques like postural drainage, chest percussion and vibration, and breathing retraining, aims to eliminate bronchial secretions and enhance ventilation, reducing the risk of respiratory infections.
Recommend the use of soft-bristled toothbrushes and stool softeners to protect mucous membranes. Hard-bristled toothbrushes can compromise mucous membrane integrity, providing a potential entry point for pathogens. Soft-bristled toothbrushes are gentler on the gums, reducing the risk of irritation. Inflamed gums are more susceptible to infection.
Promote nail care by keeping the client’s and the nurse’s fingernails short and clean: Rough edges or hangnails can harbor microorganisms. Maintaining proper hand hygiene includes regularly cleaning and trimming fingernails, which may accumulate dirt and germs, contributing to the spread of infections. Short nails are preferable, as longer nails can harbor more dirt and bacteria, increasing the risk of infection (Centers for Disease Control and Prevention, 2022).
Encourage sleep and rest: Adequate sleep is crucial for modulating immune responses. Insufficient sleep can weaken immunity, raising susceptibility to infections. Establishing a regular sleep routine enhances the immune system’s effectiveness, ensuring appropriate and efficient immune responses (Bagnoli. 2022).
Assist the client in learning stress-reducing techniques: Excessive stress can predispose clients to infections. Engaging in stress-reduction techniques, such as meditation, deep breathing exercises, or mindfulness practices, helps lower stress hormones, promoting a more balanced immune response.
Follow proper cleaning or disinfecting procedures for clients and their environment: Avoid contact with soiled items using uniforms, and refrain from shaking bed linens or clothes; instead, dust with a damp cloth as needed. Microorganisms can become airborne and be inhaled by clients and healthcare workers. Cleaning contaminated objects, sterilizing or disinfecting equipment, and following agency policies for client rolls control the site or source of microorganism growth (McCutcheon. 2015).
Avoid eating or drinking in the client’s or resident’s areas: Eating and drinking increase the risk of transmitting infections between healthcare providers and clients. To sustain itself, a pathogen must position itself for transmission to a new host, typically leaving the infected host through a portal of exit. The mouth is a common portal of exit; therefore, eating in designated areas away from infectious clients minimizes the risk of infection (Ernst Meyer, 2019).
Avoid wearing or remove artificial nails and nail extenders: Keep nails at a minimum length. Artificial nails and nail extenders can increase bacterial load up to nine times compared to bacteria found on natural nails. Healthcare workers are discouraged from using extenders or artificial nails. Nails should not exceed ¼-inch in length and should not extend beyond the fingertips. Most microbes on hands originate from under the fingernails, and longer nails are harder to clean, increasing the risk of punctures in gloves from the thumb and forefinger (McCutcheon. 2015).
Use warm water and appropriate products during hand hygiene: Warm water is effective in removing less protective oils compared to hot water, as hot water can increase the likelihood of skin damage. Products should be dispensed in disposable pump containers to prevent contamination. An adequate amount of soap is necessary to dissolve fatty materials and oils from hands, as water alone is insufficient for cleaning soiled hands.
Always carry an alcohol-based hand rub, especially during client care: Alcohol-based hand rubs with a concentration of 60 to 90% alcohol are recommended for hand hygiene in healthcare settings. This product is the preferred method of hand hygiene, surpassing soap and water in effectiveness. Alcohol-based hand rubs can kill the majority of germs and viruses on hands, require less time to use than soap and water, and are easily accessible at the point of care (McCutcheon.,2015).
Provide micronutrient supplementation as appropriate. Supplementation with micronutrients and omega-3 fatty acids offers a safe, effective, and cost-efficient approach to address nutritional gaps and support optimal immune function, thereby reducing the risk and consequences of infections.

Vitamins and Trace Elements: These micronutrients play vital roles in supporting immune system cells and tissues. Consider adding a multivitamin and trace element supplement that meets nutrient requirements for vitamins (A, B6, B12, and folate) and trace elements (zinc, iron, selenium, and magnesium, copper) to a well-balanced diet.

Vitamin C: Doses exceeding 200 mg/day provide saturating blood levels, reducing the risk, severity, and duration of upper and lower respiratory tract infections. During infection, individuals may take 1 to 2 g/day.

Vitamin D: Daily supplementation reduces the risk of acute respiratory tract infections. A recommended daily intake of 2000 IU/day is advised.

Zinc: Marginal zinc deficiency can impact immunity, particularly in children, leading to increased respiratory and diarrheal morbidity. Recommended daily intake is in the range of 8 to 11 mg/day.

Omega-3 Fatty Acids (EPA+DHA): Supporting an effective immune system, omega-3 fatty acids aid in inflammation resolution. A daily intake of 250 mg/day is recommended (Calder et al., 2020).

Ensure that all staff and employees are up-to-date with their vaccinations and physical examinations offered by the facility. Healthcare employees should be encouraged to receive annual influenza vaccinations. Periodic tests for latent tuberculosis should be conducted to assess for new exposures. Proactive campaigns and policies should be developed by employee health services to engage employees in their well-being and infection prevention (Habbas.,2023).
Implement antimicrobial stewardship programs strictly. Hospitals are increasingly adopting antimicrobial stewardship programs to control resistance, improve outcomes, and reduce costs. These programs should monitor antimicrobial susceptibility profiles, anticipate and assess new resistance patterns, and correlate trends with antimicrobial agents used for susceptibility evaluation (Habbas. 2023).
Collaborate with healthcare professionals in developing infection control policies and interventions. The infection control program’s primary purpose is to develop, implement, and evaluate policies and interventions to minimize the risk of hospital-acquired infections (HAIs). Interventions can be vertical or horizontal, targeting single or multiple pathogens, respectively. Examples include surveillance cultures and isolation for MRSA (vertical) and hand hygiene initiatives (horizontal) (Habbas. 2023).
Promote appropriate oral hygiene: Despite oral care often receiving low priority, research links poor oral hygiene to infection spread, poor health outcomes, and compromised nutrition. Oral care, including brushing after meals and before bedtime, is essential (Ernst Meyer., 2019).

Encourage the client to take a bath daily: Daily bathing, although perceived as time-consuming, significantly reduces infection spread. Using chlorhexidine gluconate wipes or solutions has shown to be effective, surpassing traditional soap and water baths in decreasing HAIs. Wash basins can also serve as reservoirs for pathogens (Ernst Meyer., 2019).
Disinfect mobile phones and other gadgets frequently. Research indicates that mobile devices carry numerous pathogens and are dirtier than common surfaces. Frequent disinfection with wipes is crucial to prevent disease spread, especially as clients, staff, and visitors bring these devices into healthcare facilities (Ernst Meyer., 2019).

Implementing Isolation Precautions

Infection control programs are designed to prevent and halt the transmission of infections. Specific precautions are necessary to curb infection transmission based on the type of microorganisms involved.
Instruct the client not to share personal care items (e.g., toothbrushes, towels, etc.). Explain to the client the potential for infection transmission when sharing personal items. Razors, toothbrushes, towels, combs, and makeup can harbor bacteria, viruses, fungi, and other microorganisms. Razors, in particular, may pose a risk of transmitting blood borne pathogens if they accidentally break the skin. Encourage the avoidance of sharing these items to reduce the likelihood of spreading infections.
Limit visitors and reinforce the reporting of signs of infection. Restricting visitation helps minimize the transmission of pathogens. The most effective way to prevent infection spread is to avoid contact with others when experiencing symptoms. It is crucial to inform clinicians, staff, and clients to refrain from contact if they exhibit symptoms or signs of respiratory infections until they are asymptomatic or no longer contagious (DePaola & Grant, 2019).
Provide surgical masks to visitors who are coughing and explain the rationale for enforcing usage. Instruct visitors to cover the mouth and nose (using the elbows) during coughing or sneezing, use tissues to contain respiratory secretions with immediate disposal into a no-touch receptacle, and perform hand hygiene afterward.
Educating visitors on preventing droplet transmission from themselves to others reduces the risk of infection. Masks covering the mouth and nose should be worn during all interactions with the client or while providing care. Ensure each client room is equipped with protective barriers, changed after each client. Garbage receptacles should be readily available for the disposal of soiled products in both client rooms and common spaces (DePaola & Grant, 2019).
Place the client in protective isolation if the client is at high risk of infection. Protective isolation, also known as reverse isolation, is implemented when the white blood cell (WBC) count indicates neutropenia. This precaution is specifically recommended for clients with low neutrophil levels. Neutropenic clients should be assigned to a single-client room with proper ventilation, if available (Monty.,2018).

Standard Precautions

The foundation of standard precautions lies in the assumption that all clients are either colonized or infected with microorganisms, irrespective of the presence of signs and symptoms. As a result, a consistent and universal level of caution is advocated for the care of all clients. The key components of standard precautions encompass proper hand hygiene, the utilization of personal protective equipment (PPE), appropriate management of client care equipment and linens, environmental control, prevention of injuries from sharp devices, and strategic client room assignments within healthcare facilities.
Hand Hygiene: Frequent hand washing or decontamination is crucial during client care. If hands are visibly dirty or contaminated with biological material from client care, washing with soap and water is essential. In situations where hands are not visibly soiled, healthcare providers are strongly recommended to use alcohol-based, waterless antiseptic agents for routine hand decontamination.
Glove Use: Gloves should be worn whenever a healthcare worker comes into contact with any client secretions or excretions and must be discarded after each client care interaction. Gloves serve as an effective barrier, protecting hands from the microflora associated with client care.
Needle stick Prevention: Extreme caution is imperative when handling needles, scalpels, and other sharp objects. Used needles should not be recapped; instead, they should be placed directly into puncture-resistant containers located near their point of use. In situations where recapping is deemed necessary, a one-handed approach should be employed to reduce the risk of skin puncture.
Avoidance of Splash and Spray: When engaged in activities where body fluids may be sprayed or splashed, healthcare professionals must utilize appropriate barriers such as goggles, facemasks, or cover gowns to minimize the risk of exposure.

Airborne Precautions

Airborne precautions are mandated for clients with presumed or confirmed pulmonary tuberculosis (TB), varicella, measles, or other airborne pathogens. During hospitalization, it is imperative that these clients are placed in airborne infection isolation rooms. These rooms are specifically designed with negative air pressure, rapid air turnover, and air that is either highly filtered or directly exhausted to the outside.
The appropriate personal protective equipment (PPE) for airborne precautions includes fit-tested N95 respirators. Placement of the client requires either an airborne infection isolation room or a single-client room. To maintain the effectiveness of airborne precautions, the door should be kept closed at all times, and access to the client should be limited to non-susceptible personnel. Additionally, a signage outside the client’s room may be employed to alert anyone entering about the airborne precautions in place.

Droplet Precautions

Droplet precautions are implemented for organisms such as influenza or meningococcus that can be transmitted through close contact with respiratory or pharyngeal secretions. Healthcare providers should wear facemasks when within three to six feet of the client.
The personal protective equipment (PPE) recommended for droplet precautions includes masks and goggles or face shields.

Contact Precautions

Contact precautions are employed for organisms that spread through skin-to-skin contact, such as antibiotic-resistant organisms or C. difficile. These precautions emphasize careful techniques and the use of barriers, particularly for organisms with significant epidemiological consequences. Handwashing with soap and water is preferred over alcohol-based or waterless hand products, as spores are resistant to the latter. Bleach-containing cleaning products are optimal for cleaning frequently touched equipment, to effectively eliminate spores.
The PPE for contact precautions may involve gloves and gowns, and dedicated equipment for the client might be provided. In the case of C. difficile infection, only soap and water should be used for hand hygiene.

Proper Wearing of PPE

Wear personal protective equipment (PPE) properly.

Gloves: Wear gloves when providing direct care and perform hand hygiene after properly disposing of gloves. Using two layers of gloves in surgical procedures is supported as an infection prevention technique. Different gloves offer varying levels of standards for infection prevention (Kening, 2023).
Masks: Use masks, goggles, and face shields to protect the mucous membranes of the eyes, mouth, and nose during procedures and direct-care activities (e.g., suctioning secretions) that may generate splashes or sprays of blood, body fluids, secretions, and excretions. Loosely woven cloth masks provide minimal respiratory protection, while National Institute for Occupational Safety and Health (NIOSH)-approved respirators offer the highest level of protection (Kening, 2023).
Gowns: Wear a gown for direct contact with uncontained secretions or excretions. Remove the gown and perform hand hygiene before leaving the client’s room or cubicle. Never reuse gowns, even with the same individual. USP 800 guidelines promote safety by outlining gown standards for handling hazardous drugs (Kening, 2023).
Limit client transport: Minimize client transport to essential purposes only, such as diagnostic and therapeutic procedures that cannot be performed in the client’s room. Use appropriate barriers on the client during transport, consistent with the route and risk of transmission. Notify healthcare personnel in the receiving area of the impending arrival of the client and the precautions necessary to prevent transmission (Ernst Meyer., 2019).
Institute enteric precautions: Use enteric precautions when there is the presence or suspected presence of gastrointestinal pathogens, such as Clostridium difficile or norovirus. Healthcare workers should always wear a gown in the client’s room to prevent inadvertent fecal contamination of their clothing from contact with contaminated surfaces. Use soap and water for hand hygiene, as it is recommended over hand sanitizers for C. diff. Special disinfection processes, including mattress disinfection, are essential after client discharge (Ernst Meyer., 2019).
Place signage on isolation precaution rooms: Signs specifying the required precaution for the client should be displayed on the door or at the foot of the bed. Accommodation in a private room or cohorting clients with the same type of infection is acceptable. Private bathrooms for each client are preferred (McCutcheon. 2015).
Perform appropriate and systematic donning of PPE: Put on PPE just before interacting with the client and remove it immediately after the interaction, followed by hand hygiene.

Donning of PPE

Remove rings, bracelets, and watches, then perform hand hygiene.
Apply a waterproof long-sleeved gown and tie the neck and waist strings to prevent potential cross-contamination from blood or body fluids onto forearms and the body.
Apply a surgical or N95 mask, ensuring a secure fit with no air leaks, as a poor-fitting mask is the primary cause of pathogen exposure for healthcare providers.
Apply goggles or face shields to prevent accidental exposure to the eyes, nose, and mouth. Goggles can be placed on top of eyeglasses.
Apply non-sterile gloves over the top of the gown cuff to ensure complete coverage of the skin on the arms during direct client care (Ernstmeyer., 2019).

Doffing of PPE

Remove gloves first by grasping the outer edge by the wrist, peeling away from the hand. With the bare hand, reach under the second glove, gently peel it down off the fingers, and then perform hand hygiene.
Remove the gown without contaminating clothing. Starting at the neck ties, pull the outer part forward, roll it inward into a ball, and discard it in the appropriate container. Then, perform hand hygiene.
Remove eye protection or face shield, handling only by the sides, as the arms of goggles and the headband on the face shield are considered clean. The front of the face shield or goggles is contaminated.
Remove the mask or N95 respirator. Ties, earlobe loops, or straps are considered clean and may be touched. If tied, remove the bottom tie first, then the top tie. Remove ear loops or straps by leaning forward to allow the mask to slip off the face. Then, perform hand hygiene (Ernstmeyer.,2019).

Promoting Surgical Asepsis

Perform a thorough surgical scrubbing before a surgical procedure. Traditionally, surgeons, surgical assistants, and nurses prepare for surgery by scrubbing their hands and arms with antiseptic soap and water. Some institutions may use alcohol-based products or scrub-less soaps, effective only in the absence of gross contaminants.
Wear the appropriate PPE for surgical procedures. Surgical team members don long-sleeved, sterile gowns and gloves, cover their heads with caps, and wear masks over the nose and mouth to minimize the risk of upper respiratory tract bacteria entering the wound. Only personnel who have scrubbed, gloved, and gowned touch sterilized objects during surgery.
Prepare the area of the client’s body for the surgical procedure meticulously. Cleanse an area larger than necessary exposure during surgery, applying an antiseptic solution. If hair removal is necessary, use electric clippers immediately before the procedure to minimize infection risk.
Ensure that any articles used are properly disinfected or sterilized before use. Sterilize all surgical supplies, instruments, needles, sutures, dressings, gloves, covers, and solutions that may contact the surgical wound or exposed tissues. Only personnel who have scrubbed, gloved, and gowned should handle sterilized objects.
Avoid touching a sterile object or prevent it from being touched by a non-sterile object. Sterile objects should only be touched by sterile equipment or sterile gloves. When an object’s sterility is questionable, consider it non-sterile. Keep forceps’ tips down during the procedure to prevent fluid from contaminating the sterile field.
Ensure that all sterile items must be placed above waist level. Keep sterile equipment and sterile gloves above waist level, as items held below the waist or below waist level are considered non-sterile.
Always keep the sterile field within sight. The sterile field must remain visible during the entire procedure for it to be considered sterile. Avoid turning away from the sterile field, and maintain at least a one-foot distance to prevent inadvertent contamination.
Take care to avoid contamination when opening sterile equipment. Dispense items to a sterile field in ways that preserve the sterility of the items and the integrity of the sterile field. After opening a sterile package, consider the edges unsterile. Deliver sterile supplies to a sterile field or a scrubbed person to maintain the sterility of the object or fluid.
Do not use sterile equipment with any puncture, moisture, or tear through the sterile barrier. Whenever a sterile barrier is breached, the area must be considered contaminated. A tear or puncture of the drape permitting access to an unsterile surface underneath renders the area unsterile. Such equipment must be replaced.
Avoid touching the border around the edge of a sterile field. Once a sterile field is set up, the border of one inch at the edge of the sterile drape is considered non-sterile. Sterile drapes are used to create a sterile field. Place all objects inside the sterile field and away from the one-inch border.
Constantly monitor every sterile field. Every sterile field is constantly monitored and maintained. Items of doubtful sterility are considered unsterile. Sterile fields are prepared as close as possible to the time of use to prevent contamination from exposure to microorganisms.
Ensure that movement around and in the sterile field will not compromise or contaminate it. Do not sneeze, cough, laugh, or talk over the sterile field. Maintain a safe space or margin of safety between sterile and non-sterile objects and areas to avoid contamination. Never reach over a sterile field. When pouring sterile solutions, only the lip and inner cap of the pouring container are considered sterile; therefore, the container must not touch any part of the sterile field and splashes must be avoided (McCutcheon & Doyle, 2015).
Select sterile or clean gloves based on the need to touch key parts directly. There are two different levels of medical-grade gloves available to healthcare workers: clean gloves and sterile gloves. Clean gloves are used whenever there is a risk of contact with body fluids or contaminated surfaces or objects. Sterile gloves meet FDA requirements for sterilization and are used for invasive procedures or when contact with a sterile site, tissue, or body cavity is anticipated (Ernstmeyer. 2021).

Maintaining Sterile Conditions in Surgical Settings

Do not use sterile equipment with any puncture, moisture, or tear through the sterile barrier. If a sterile barrier is compromised, consider the area contaminated. Tears or punctures in drapes that allow access to an unsterile surface underneath make the equipment unsterile and necessitate replacement.
Avoid touching the border around the edge of a sterile field. Once a sterile field is established, the one-inch border around the sterile drape’s edge is considered non-sterile. All objects should be placed inside the sterile field, away from the one-inch border.
Constantly monitor every sterile field. Sterile fields are continuously monitored, and items of doubtful sterility are treated as unsterile. Preparation of sterile fields close to the time of use helps prevent contamination from exposure to microorganisms.
Ensure that movement around and in the sterile field will not compromise or contaminate it. Avoid activities like sneezing, coughing, laughing, or talking over the sterile field. Maintain a safe space between sterile and non-sterile objects to prevent contamination. Never reach over a sterile field, and when pouring sterile solutions, only consider the lip and inner cap of the pouring container sterile.
Select sterile or clean gloves based on the need to touch key parts directly. Choose between clean gloves and sterile gloves based on the risk of contact. Clean gloves are for situations involving body fluids or contaminated surfaces, while sterile gloves, meeting FDA sterilization requirements, are used for invasive procedures or anticipated contact with sterile sites, tissues, or body cavities.

Client and Caregiver Education for Infection Prevention

Educate the client and caregivers about the infectious process. Provide empathetic and sensitive education to clients and caregivers about the nature of infectious diseases, addressing any concerns or anxieties and ensuring a clear understanding of the condition.
Instruct caregivers to obtain accurate temperature readings. Stress the importance of obtaining accurate temperature readings for clients with fever, as this information aids in assessing infection severity and the effectiveness of antibiotic therapy.
Educate clients and caregivers about appropriate cleaning, disinfecting, and sterilizing items. Provide knowledge on reducing or eliminating germs through proper cleaning, sanitizing, and disinfecting practices, emphasizing the importance of cleaning surfaces before applying sanitizing or disinfecting agents.
Teach the importance of avoiding contact with individuals who have infections or colds. Emphasize physical distancing. Educate on the risk of infection transmission through direct contact, contaminated objects, or air currents, stressing the significance of avoiding contact with infected individuals and practicing physical distancing.
Demonstrate and allow return demonstration of high-risk procedures. Ensure that clients and caregivers master necessary skills for procedures like dressing changes or IV site care through demonstrations and return demonstrations, enhancing their ability to perform these tasks correctly after discharge.
Teach the purpose and proper technique for maintaining isolation. Educate clients, families, and caregivers on the importance of isolation procedures, helping them understand and cooperate with specific precautions to prevent the spread of infectious organisms.
Instruct clients to take anti-infectives as prescribed and complete the full course. Emphasize the importance of completing prescribed antibiotic regimens to maintain a constant blood level of the medication, prevent drug resistance, and ensure the complete eradication of the infection.
Instruct clients and caregivers to remind healthcare workers about infection control procedures. Empower clients and caregivers to remind healthcare workers about proper infection control procedures, particularly hand hygiene, fostering a collaborative approach to infection prevention.
Provide information about the importance of vaccines and participation in vaccination programs. Educate clients on the significance of vaccines and encourage participation in vaccination programs, especially for diseases like influenza, pneumococcus, meningococcus, and others.
Educate clients to report any problems after vaccination. Instruct clients to report any issues encountered after vaccination and facilitate the completion of Vaccine Adverse Event Reporting System (VAERS) forms as required by law. Instruct caregivers to regularly disinfect all equipment and surroundings of the client. Use aseptic technique as indicated. Stress the importance of meticulous disinfection and aseptic technique when using medical equipment, with special attention to catheter-related care to promptly identify and report signs of infection.

REFFERENCES

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Centers for Disease Control and Prevention. (2023). How to Protect Yourself & Others. https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/prevention.html

DePaola, L. G., & Grant, L. M. (2019). Infection Control in Home Care and Hospice. Springer Publishing Company.

Ernstmeyer, K., & Christman, L. (2019). Infection prevention: New perspectives on an old concept. Nursing Made Incredibly Easy!, 17(6), 26-34.

Habboush, Y., Zell, K., Whalen, M., Ostroff, S., & Rao, G. G. (2023). The Impact of the COVID-19 Pandemic on Healthcare-Associated Infections in New York State. Infection Control & Hospital Epidemiology, 1-6.

Kening, L. (2023). Understanding Surgical Scrubbing. https://www.news-medical.net/health/Understanding-Surgical-Scrubbing.aspx

McCutcheon, K., & Doyle, M. (2015). Infection Control: A Handbook for Community Nurses. McGraw-Hill Education.

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