Empower your nursing practice with this comprehensive nursing care plan and management guide, specifically designed to support nurses in providing optimal care for patients at risk for infection. Gain a deeper understanding of nursing assessments, evidence-based interventions, realistic goals, and nursing diagnoses tailored to infection prevention and control. By utilizing this guide, nurses can enhance their skills in identifying, preventing, and managing infections.
Table of Contents
- What is the risk for infection and infection control?
- Causes of infection
- Nursing Care Plans and Management
- Nursing Problem Priorities
- Nursing Assessment
- Nursing Diagnosis
- Nursing Goals
- Nursing Interventions and Actions
- Recommended Resources
- References and Sources
What is the risk for infection and infection control?
Infections occur when the natural defense mechanisms of an individual are inadequate to protect them. Microorganisms such as bacteria, viruses, fungi, and other parasites invade susceptible hosts through inevitable injuries and exposures. People have dedicated cells or tissues that deal with the threat of infection. These are known as the immune system.
The human immune system is crucial for survival in a world full of potentially deadly and harmful microbes. The serious impairment of this system can predispose to severe, even life-threatening, infections. Organs and tissues involved in the immune system include the thymus, bone marrow, lymph nodes, spleen, appendix, tonsils, and Peyer’s patches (in the small intestine). If the client’s immune system cannot battle the invading microorganism sufficiently, an infection occurs.
Breaks in the integrity of the integument, mucous membranes, soft tissues, or even organs such as the kidneys and lungs can be sites for infections after trauma, invasive procedures, or invasion of pathogens through the bloodstream or lymphatic system. A complete chain of events is necessary for infection to occur. Six elements are necessary, including 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 is also important to recognize the difference between infection and infectious disease. Infectious disease is the state in which the infected host displays a decline in wellness due to the infection. When the host interacts immunologically with an organism but remains symptom-free, the definition of infectious disease has not been met.
A common means for infectious diseases to spread is by directly transferring bacteria, viruses, or other germs from one person to another. This can transpire via contact, airborne, sexual contact, or sharing of IV drug paraphernalia. Also, having inadequate resources, lack of knowledge, and being malnourished place an individual at high risk of developing an infection.
SEE ALSO: Infection Control in Nursing
Infections prolong healing and can result in death if left untreated. Antimicrobials are widely used to treat infections when susceptibility is present. However, no antimicrobial is effective for some organisms, such as the human immunodeficiency virus (HIV). Another common medical intervention is called immunization. This is also universally used for those who are at high risk for infection. Handwashing is the best way to break the chain of infection.
Infection control refers to the policy and procedures implemented to control and minimize the dissemination of infections in hospitals and other healthcare settings with the main purpose of reducing infection rates. The primary purpose of infection control programs was to focus on the surveillance of hospital-associated infections (HAIs) and incorporate the basic understandings of epidemiology to elucidate risk factors for HAIs (Habboush et al., 2023).
Specific nursing interventions will depend on the nature and severity of the risk. Clients should be informed and well-educated by nurses on recognizing the signs of infection and how to reduce their risk.
Causes of infection
Various health problems and conditions can create a favorable environment that would encourage the development of infections. Here are the common causes of infection and factors that place a client at risk for infection.
Inadequate primary defenses. These are the body’s first line of defense against infection and they include the skin, mucous membranes, and normal flora. Examples of inadequate primary defenses include:
- A break in the skin, such as a cut or wound
- Tissue damage, such as from burns or frostbite
- Dry skin
- Mucous membranes that are not moist, such as from dehydration
- A lack of normal flora, such as from antibiotics
Insufficient knowledge to avoid exposure to pathogens. This is a lack of knowledge about how to prevent infection. Examples of insufficient knowledge to avoid exposure to pathogens include:
- Not knowing how to wash hands properly
- Not knowing how to prevent the spread of germs
- Not knowing how to clean and disinfect surfaces
- Not knowing how to handle food safely
Compromised host defenses. These are the body’s second line of defense against infection and include the immune system, white blood cells, and inflammation. Examples of compromised host defenses include:
- Diabetes mellitus
- Chronic diseases, such as heart disease, lung disease, and kidney disease
- Medications, such as chemotherapy and steroids
Compromised circulation. This is a decrease in blood flow to the tissues. Examples of compromised circulation include:
- Peripheral vascular disease
- Diabetes mellitus
A site for organism invasion. This is an opening in the body that allows pathogens to enter. Examples of a site for organism invasion include:
- A surgical wound
- A burn
- A break in the skin
- A urinary tract infection
- A respiratory infection
- A central venous line
- An enteral feeding tube
Contact with contagious agents. This is exposure to pathogens that can cause infection. Examples of contact with contagious agents include:
- Being around someone who is sick
- Touching something that is contaminated
- Not covering your mouth when you cough or sneeze
Increased vulnerability of the infant. This is a condition that makes an infant more susceptible to infection. Examples of increased vulnerability of infants include:
- Being born prematurely
- Low birth weight
- Congenital heart defect
- Cleft lip or palate
- Weakened immune system
Chronic diseases. These are long-term health conditions that can weaken the immune system. Examples of chronic diseases include:
- Heart disease
- Lung disease
- Kidney disease
- Diabetes mellitus
Multiple sex partners. Having multiple sex partners and not practicing safe sex can increase the risk of infection.
Lack of immunization. Infection can occur or be severe when an individual is not vaccinated against a disease.
Nursing Care Plans and Management
Nursing care plans for infection focus on comprehensive assessment, early detection, prompt treatment, and education for both clients and healthcare providers. These plans aim to minimize the risk of healthcare-associated infections and promote the well-being of clients in various healthcare settings, including hospitals, long-term care facilities, clinics, and home care.
Nursing Problem Priorities
The following are the nursing priorities for clients with a risk for infection:
- Infection control and prevention. Nurses must prioritize implementing infection prevention measures to minimize the risk of infection spreading.
- Assessment and early detection. The early identification of the infection is essential for prompt intervention. Early detection allows for the timely 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 utilize necessary barriers to ensure safety.
- Surgical asepsis. Rigorous adherence to the principles of surgical asepsis is basic to preventing surgical site infections.
- Client and caregiver education. Client and caregiver education increases awareness and understanding of infection prevention strategies, thus decreasing the risk of infection.
Signs and symptoms of infection can vary depending 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 can be accompanied by chills and sweating.
- Pain or tenderness. Infections can cause localized pain or tenderness at the site of infection.
- Redness and swelling. Inflammation is the hallmark of infection and is often characterized by redness, warmth, and swelling.
- Tachycardia and tachypnea. Infections can cause an elevation in heart rate and respiratory rate as the body tries to fight off the pathogens.
- Malaise. A general feeling of discomfort, uneasiness, or being unwell.
- Increased white blood cell count. In response to an infection, the body may produce more WBCs, leading to an elevated WBC.
A risk of infection can be identified when there is a potential for the client to develop an infection due to various factors or circumstances. The diagnosis is based on a comprehensive assessment of the client’s health history, and risk factors that can compromise the immune system. Nurses must utilize their expertise to identify specific risk factors and collaborate with other healthcare professionals to develop targeted interventions aimed at preventing the occurrence of infections.
Here are some sample patient goals and expected outcomes for patients at risk for infection.
- The client will remain free of infection, as evidenced by normal vital signs and the absence of signs and symptoms of infection.
- The client will maintain or restore defenses.
- Early recognition of infection to allow for prompt treatment.
- The client will demonstrate a meticulous hand-washing technique.
- Alleviate or reduce the problems related to the infection.
Nursing Interventions and Actions
Assessment is paramount in identifying factors that may precipitate infection. Use the nursing assessment guidelines below to identify the subjective data and objective data for the risk-for-infection care plan:
1. Performing Assessment and Early Detection
Identifying an infection in its early stages enables healthcare professionals to prescribe the appropriate antimicrobial agents or interventions to target the specific pathogen causing the infection.
Assess for the presence, existence, and history of the common causes of infection (listed above).
These factors represent a break in the body’s normal first line of defense and may indicate an infection. The types of microorganisms that cause infections are bacteria, rickettsiae, viruses, protozoa, fungi, and helminths.
Assess for the presence of local infectious processes in the skin or mucous membranes.
Signs and symptoms include localized swelling, localized redness, pain or tenderness, loss of function in the affected area, and palpable heat. A client colonized with S. aureus may have staphylococci on the skin without any skin interruption or irritation. However, if the client has an incision, s. Aureus could enter the wound, resulting in an immune system reaction of local inflammation and migration of white cells to the site.
Monitor and report any signs and symptoms of infection. Signs and symptoms of infection vary according to the body area involved. Assess for the following signs and symptoms:
- Redness, swelling, increased pain, a purulent discharge from incisions, injury, and exit sites of tubes (IV tubings), drains, or catheters.
These are the classic signs of infection. Any suspicious drainage should be cultured; antibiotic therapy is determined by the pathogens identified. Approximately 20% of clients are 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 (Tenke et al., 2017).
- Elevated temperature.
Fever is often the first sign of an infection. A temperature of up to 38º C (100.4º F) 48 hours post-op is usually related to surgical stress after 48 hours. A temperature greater than 37.7º (99.8º F) may indicate infection; a very high temperature accompanied by sweating and chills may indicate septicemia. In a prospective study of older adult clients, it was demonstrated that a tympanal body temperature higher than 37.3º (99.14º F) and a rectal body temperature higher than 37.8º (100.4º F) is a reliable marker of a bacterial infection (Debonera & Simmons, 2021).
- Color of respiratory secretions.
Yellow or yellow-green sputum is indicative of respiratory infection. A type of white blood cell known as neutrophil has a green color to them. These types of WBCs are attracted to the scene of bacterial infections, and therefore bacterial infections of the lower respiratory tract, such as pneumonia, may result in the production of green sputum (Eldridge, 2023).
- The appearance of urine.
Cloudy, turbid, foul-smelling urine with visible sediment is indicative of urinary tract or bladder infection. However, recently it has been reported that visual inspection of the urine is not helpful. Cloudiness of the urine most often is due to protein or crystal presence, and malodorous urine may be due to diet or medication use. Urine cultures should be obtained in these cases (Brusch & Stuart, 2023).
Monitor white blood cell (WBC) count.
An increasing WBC count indicates the body’s efforts to combat pathogens. This is referred to as leukocytosis and is composed primarily of neutrophils. It is commonly a sign of an inflammatory response such as infection but can occur during parasitic infections or cancers such as leukemia (Rowe, 2022). Rates are as follows:
- Low: below 4,500
- Normal: 4,500 – 11,000
- High: more than 11,000
- A very low WBC count may indicate a severe risk for infection. In older adult clients, the infection may be present without an increased WBC count. Additionally, WBC differential may show an increase and decrease in certain infections.
Assess and monitor nutritional status, weight, history of weight loss, and serum albumin.
Clients with inadequate nutrition may be anergic or unable to muster a cellular immune response to pathogens, making them susceptible to infection. Deficiencies or suboptimal status in micronutrients negatively affect immune function and can decrease resistance to infections. Vitamin D deficiency increases the risk of respiratory infection (Calder et al., 2020).
Investigate the use of medications or treatment modalities that may cause immunosuppression.
Antineoplastic agents, corticosteroids, and so on can suppress immune function. Corticosteroids and tumor necrosis factor inhibitors are two types of medications that can increase a client’s chances of acquiring a fungal infection (Centers for Disease Control and Prevention, 2020). Immunosuppressant is 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 not have sufficient acquired active immunity. The nurse may ask clients during history taking when they were last immunized. Risks and benefits for the person and the community must be evaluated in terms of morbidity, mortality, and financial cost and benefit. Successful vaccine programs have 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 that appears in older clients must be reported as it could potentially be an infection. Older adults often present with a non-specific decline from their baseline functional status. Cognitive impairment contributes to the atypical presentation of infections, which further reduces their capacity to communicate symptoms. Fever can 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.
Integrating travel history in assessment can help stem possible outbreaks and help put infectious symptoms in context for the healthcare team. As many as 43 to 79% of travelers to low- and middle-income countries become ill with travel-associated health problems. Most post-travel infections become apparent soon after returning from abroad, but incubation periods vary, and some syndromes can present months to years after the initial infection or after travel (Fairley, 2023).
Determine the client’s travel exposures.
Knowing the client’s exposures during travel, such as consumption of contaminated food or water, insect bites, and freshwater swimming, can also assist with differential diagnosis. Accommodations and activities can also influence the risk of acquiring certain diseases while abroad. Travelers who visit friends and relatives are at greater risk for malaria, typhoid fever, and other diseases, often because they stay longer, travel to more remote destinations, have more contact with local water resources, and typically do not seek pretravel advice (Fairley, 2023).
For pregnant clients, assess the intactness of amniotic membranes.
Prolonged rupture of amniotic membranes before delivery puts the mother and neonate at increased risk for infection. Many pregnant clients with infections are asymptomatic, necessitating both a high degree of clinical awareness and adequate screening (Smith & Basistha, 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 hymeneal ring and rectally beyond the sphincter. This may reveal the presence of group B streptococcus, which is the most common cause of life-threatening infections in newborns (Smith & Basistha, 2023).
Determine factors that can reduce the effectiveness of hand hygiene.
The condition of the hands can influence the effectiveness of hand hygiene. Skin cracks, dermatitis, or cuts can trap bacteria and place clients at an increased risk. Rings and bracelets increase the microbial count on hands. In an instance where a bracelet may not be removed for religious reasons, the bracelet may be pushed as high as possible above the wrist before performing hand hygiene (McCutcheon & Doyle, 2015).
Assess for a history of latex allergy.
A latex allergy is a reaction to the proteins in natural rubber latex. When people come into contact with latex, an allergic reaction may occur. Note that powdered latex gloves have also been associated with latex allergies. People at risk for developing a latex allergy are healthcare workers who frequently wear latex gloves, clients who have had many surgeries, clients who are often exposed to natural rubber latex, and clients with other allergies, such as allergic rhinitis or allergies to certain foods (McCutcheon & Doyle, 2015).
Perform a risk assessment for blood and body fluid exposure urgently after the incident.
A risk assessment for blood and body fluid exposure must be completed within two hours after the incident. The healthcare worker may have this done at the emergency department or an urgent care center and be assessed by the healthcare provider. The risk of exposure and the risk of transmission from the source will be assessed (McCutcheon & Doyle, 2015).
Monitor C-reactive protein (CRP) levels.
CRP is another marker of inflammation that seems to rise six hours after infection and peaks at 48 hours, has a half-life of 19 hours, and is affected by immunosenescence but not by comorbidities. It can therefore be used for therapeutic monitoring (Debonera & Simmons, 2021).
Utilize validated and reliable biomarkers for the prediction of infection among older adults.
It has become increasingly evident that additional investigation of prognostic modeling is necessary, as the aging population is rapidly increasing. The CURB-65 score, consisting of confusion, uremia, a respiratory rate of 30 breaths per minute, low blood pressure, and age 65 years or older, has been validated in older adults and it can indicate mortality and the appropriate setting for the client to receive care. The Pneumonia Severity Index (PSI) is widely applied and risk-stratifies clients with CAP to determine whether clients can be treated as inpatients or outpatients (Debonera & Simmons, 2021).
2. Infection Control and Prevention
The role of infection control is to prevent and reduce the risk of hospital-acquired infections. This can be achieved by implementing infection control programs in the forms of surveillance, isolation, outbreak management, environmental hygiene, education, and infection prevention policies and management (Habboush et al., 2023).
Maintain strict asepsis for dressing changes, wound care, intravenous therapy, and catheter handling.
The aseptic technique decreases the chances of transmitting or spreading pathogens to or between clients. Interrupting the chain of infection (see image above) effectively prevents the spread of infection. The nurse should use a scrupulous aseptic technique during the insertion of the catheter with the use of a pre-assembled, sterile, closed urinary drainage system of the smallest catheter size possible. The risk of infection is also great in open wounds, therefore, an aseptic technique is used during dressing changes and wound care.
Wash hands or perform hand hygiene before having contact with the client. Also, impart these duties to the client and their significant others and know the instances when to perform hand hygiene or “5 moments for hand hygiene”:
- Before touching a client.
- Before cleaning or aseptic procedure (wound dressing, starting an IV, etc.).
- After direct contact with body fluid
- After touching a client
- After touching the client’s surroundings.
Friction and running water effectively remove microorganisms from hands. Washing between procedures reduces the risk of transmitting pathogens from one area of the body to another. Wash hands with antiseptic soap and water for at least 15 seconds, followed by an alcohol-based hand rub. If hands were not in contact with anyone or anything in the room or if hands are not visibly dirty, use an alcohol-based hand rub and rub until dry. Plain soap is good at reducing bacterial counts, but antimicrobial soap is better, and alcohol-based hand rubs are the best (Gilmartin, 2019).
Encourage the intake of protein-rich and calorie-rich foods and encourage a balanced diet.
Proper nutrition and a balanced diet support the immune system’s responsiveness and enhance the health of all the body’s tissues. Adequate nutrition enables the body to maintain and rebuild tissues and helps keep the immune system functioning well. Nutrition intervention may have a promising potential in mitigating aging’s negative impact on immune function, thus improving resistance to infection in the older adult population. Zinc, vitamin E, and vitamin D have emerged as prominent candidates (Pae & Wu, 2017).
Change dressing and bandages that are soiled or wet.
An aseptic technique is used when cleansing the skin; dressings are changed as prescribed by the surgeon, usually on the second through the fifth postoperative days in postsurgical wounds. However, if the dressing has visible soiling, changing it is recommended after informing the healthcare provider.
Assist clients in carrying out appropriate skin hygiene.
Frequent cleansing of the skin, particularly the hands, provides a simple, inexpensive, widely used, and effective strategy for preventing self-inoculation, by reducing viral transfer to the mucous membranes of the nose, mouth, and eyes (Rivers et al., 2021).
Dispose of soiled linens properly.
Soiled linens, particularly those contaminated with bodily fluids, can harbor pathogens such as bacteria, viruses, and fungi. Proper disposal helps prevent the spread of these microorganisms, reducing the risk of infection to both the healthcare provider and clients.
Avoid talking, coughing, or sneezing over open wounds or sterile fields.
Respiratory infections are quite virulent and easily transmitted throughout populations. These pathogens are easily aerosolized and are quite contagious. Maintaining proper respiratory hygiene is critical to maintaining a healthy environment. It begins with the person afflicted recognizing their symptoms, as well as the awareness of them and those around them to maintain appropriate healthy hygiene (DePaola & Grant, 2019).
Wear gloves when handling the client’s body fluids.
Gloves provide an effective barrier for hands from the microflora associated with client care. Gloves should be worn when a healthcare worker has contact with any client secretions or excretions and must be discarded after each client care contact. After, the hands must be washed because microbial organisms colonizing the hands can proliferate in the warm, moist environment provided by gloves.
Instruct clients to perform hand hygiene when handling food or eating.
The most frequent cause of bacterial transmission in healthcare institutions is the spread of microorganisms by the hands of healthcare workers. Effective handwashing requires at least 15 seconds of vigorous scrubbing, with special attention to the area around nail beds and between fingers, where there is a high bacterial load.
Encourage increased fluid intake unless contraindicated (e.g., heart failure, kidney failure).
Fluids help promote diluted urine, frequent emptying of the bladder, and reducing the stasis of urine. This ultimately reduces the risk of bladder infection or urinary tract infection. Increased fluid intake also helps replace fluid lost during fever and helps thin secretions. Proper hydration also helps maintain the moisture balance of the skin and tissues. This is important because dry, cracked skin can provide entry points for pathogens, increasing the risk of infection.
Encourage coughing and deep breathing exercises and frequent position changes.
This helps reduce the stasis of secretions in the lungs and bronchial tree. When stasis occurs, microbial infection of the respiratory tract occurs and may lead to pneumonia. Chest physiotherapy includes postural drainage, chest percussion and vibration, and breathing retraining, and its goals are to remove bronchial secretions and improve ventilation, thus 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 the integrity of the mucous membrane and provide a port of entry for pathogens. Soft-bristled toothbrushes have bristles that are flexible and gentle on the gums and are less likely to irritate the gums. When gums are inflamed, they become 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. Appropriate hand hygiene includes diligently cleaning and trimming fingernails, which may harbor dirt and germs and can contribute to the spread of some infections. Fingernails should be kept short, and the undersides should be cleaned frequently with soap and water. Because of their length, longer fingernails can harbor more dirt and bacteria than short nails, thus potentially contributing to the spread of infection (Centers for Disease Control and Prevention, 2022).
Encourage sleep and rest.
Adequate sleep is an essential modulator of immune responses. A lack of sleep can weaken immunity and increase susceptibility to infection. For instance, shorter sleep durations are associated with a rise in suffering from the common cold. A regular sleep routine boosts the immune system, ensuring appropriate and effective immune responses. (Ragnoli et al., 2022)
Assist the client to learn stress-reducing techniques.
Excessive stress predisposes clients to infection. Engaging in stress-reduction techniques, such as meditation, deep breathing exercises, or mindfulness practices, can help lower stress hormones and promote a more balanced immune response.
Follow proper cleaning or disinfecting procedures of clients and their environment.
Avoid contact of soiled items with uniforms and avoid shaking bed linens or clothes; instead, dust with a damp cloth as required. Microorganisms can be expelled through the air and inhaled by clients and healthcare workers. Clean contaminated objects and sterilize or disinfect equipment and client rolls according to agency policy. These environmental controls will control the site or source of microorganism growth (McCutcheon & Doyle, 2015).
Avoid eating or drinking in the client’s or resident’s areas.
Eating and drinking increases the risk of transmission of infection between healthcare providers and clients. For a pathogen to continue to exist, it must put itself in a position to be transmitted to a new host, leaving the infected host through a portal of exit. One of the most common portals of exit is the mouth, therefore, eating in a designated area away from infectious clients may minimize the risk of infection (Ernstmeyer & Christman, 2019).
Avoid wearing or remove artificial nails and nail extenders. Cut nails to a minimum length.
Artificial nails and nail extenders increase the viral load of bacteria up to nine times compared with bacteria found on hands. Extenders or artificial nails are not recommended for healthcare workers. Nails should be a maximum of ¼-inch long and should not extend past the end of the finger. Most microbes on hands come from under the fingernails. Additionally, long fingernails are harder to clean and may lead to more frequent punctures in gloves from the thumb and forefinger (McCutcheon & Doyle, 2015).
Use warm water and products when during hand hygiene.
Warm water removes less protective oils than hot water, whereas hot water increases the likelihood of skin damage. To prevent contamination, products must be dispensed in a disposable pump container that is not topped up. An adequate amount of soap is required to dissolve fatty materials and oils from hands as water alone is not sufficient to clean soiled hands.
Always carry an alcohol-based hand rub, especially during client care.
Alcohol-based hand rub is a product containing 60 to 90% alcohol concentration and is recommended for hand hygiene in healthcare settings. This product is the preferred method of hand hygiene and is more effective than washing hands with soap and water. They can kill the majority of germs and viruses from hands and requires less time to use than soap and water. ABHRs are also easy to use and have high levels of availability at the point of care (McCutcheon & Doyle, 2015).
When exposed to potentially infectious blood and body fluids, wash the affected area thoroughly and refer to the agency’s policy regarding blood or body fluid exposure.
Post-exposure management is only required when percutaneous, permucosal, or non-intact skin is exposed; the exposure is to blood or potentially infectious body tissue or fluid; the source is considered potentially infectious; and the exposed person is considered susceptible to HIV, hepatitis B, or hepatitis C. wash the exposed area thoroughly with soap and water, or normal saline for mucous membranes. Do not promote bleeding of percutaneous injuries by cutting, scratching, or squeezing the skin (McCutcheon & Doyle, 2015).
Provide micronutrient supplementation as appropriate.
Supplementation with micronutrients and omega-3 fatty acids is a safe, effective, and low-cost way to help eliminate nutritional gaps and support optimal immune function, and therefore reduce the risk and consequences of infections.
- Vitamins and trace elements
These micronutrients play important roles in supporting the cells and tissues of the immune system. A multivitamin and trace element supplement that supplies the nutrient requirements for vitamins and trace elements including vitamin A, B6, B12, and folate, and trace elements including zinc, iron, selenium, magnesium, and copper, may be added to the consumption of a well-balanced diet.
- Vitamin C
Doses of >200 mg/day provide saturating levels in the blood, and support reduction in the risk, severity, and duration of upper and lower respiratory tract infections. Requirements for vitamin C increase during infection. Individuals who are sick may take 1 to 2 g/day.
- Vitamin D
Daily supplementation of vitamin D reduces the risk of acute respiratory tract infections. A daily intake of 2000 IU/day is recommended.
Marginal zinc deficiency can impact immunity. Those deficient in zinc, particularly children, are prone to increased diarrheal and respiratory morbidity. The recommended daily intake is in the range of 8 to 11 mg/day.
- Omega-3 fatty acids (EPA+DHA)
Omega-3 fatty acids support an effective immune system, including helping to resolve inflammation. 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 examination offered by the facility.
Healthcare employees should always be encouraged to take the annual influenza vaccination. Moreover, a periodic test for latent tuberculosis should be performed to assess for any new exposure. Employee health services should develop proactive campaigns and policies to engage employees in their well-being and prevent infections (Habboush et al., 2023).
Implement antimicrobial stewardship programs strictly.
Hospitals are increasingly adapting antimicrobial stewardship programs to control antimicrobial resistance, improve outcomes, and reduce healthcare costs. Antimicrobial stewardship should be programmed to monitor antimicrobial susceptibility profiles to anticipate and assess any new antimicrobial resistance patterns. These trends need to be correlated with the antimicrobial agents used to evaluate susceptibility (Habboush et al., 2023).
Collaborate with healthcare professionals in developing infection control policies and interventions.
The main purpose of the infection control program is to develop, implement, and evaluate policies and interventions to minimize the risk of hospital-acquired infections (HAIs). Interventions that impact infection control include vertical and horizontal interventions. The vertical interventions include the reduction of risk from a single pathogen, such as surveillance cultures and subsequent isolation of clients infected with MRSA. horizontal interventions target multiple different pathogens that are transmitted in the same mechanism such as hand hygiene (Habboush et al., 2023).
Promote appropriate oral hygiene.
Although oral care may be given a low priority, research has found that poor oral care is associated with the spread of infection, poor health outcomes, and poor nutrition. Oral care should be performed in the morning, after meals, and before bedtime (Ernstmeyer & Christman, 2019).
Encourage the client to take a bath daily.
Daily bathing is another intervention that may be viewed as time-consuming and receive low priority, but it can have a powerful impact on decreasing the spread of infection. Studies have shown a significant decrease in HAIs with daily bathing using chlorhexidine gluconate wipes or solutions. The use of traditional soap and water baths does not reduce infection rates as significantly as chlorhexidine products and wash basins have also been shown to be a reservoir for pathogens (Ernstmeyer & Christman, 2019).
Disinfect mobile phones and other gadgets frequently.
Research has shown that cell phones and mobile devices carry many pathogens and are dirtier than a toilet seat or the bottom of a shoe. Clients, staff, and visitors routinely bring these mobile devices into healthcare facilities, which can cause the spread of disease. Nurses should frequently wipe mobile devices with disinfectant wipes and educate the client and caregivers to do so as well (Ernstmeyer & Christman, 2019).
3. Implementing Isolation Precautions
Infection control programs have the main purpose of preventing and stopping the transmission of infections. Specific precautions are needed to prevent infection transmission depending on the microorganisms.
Instruct the client not to share personal care items (e.g., toothbrushes, towels, etc.).
Explain to the client how infections can be transmitted from sharing personal items. Personal care items such as razors, toothbrushes, towels, combs, and makeup can harbor bacteria, viruses, fungi, and other microorganisms. Razors can also potentially transmit bloodborne pathogens when they accidentally break the skin. By avoiding sharing these items, the likelihood of spreading infection can be reduced.
Limit visitors and reinforce the reporting of signs of infection.
Restricting visitation reduces the transmission of pathogens. The best method of avoiding the spread of infections is to avoid contact with others while a person is having symptoms. It is important to inform clinicians, staff, and clients alike that if they have symptoms or show signs of respiratory infections, they should avoid contact with others until they are asymptomatic or non-contagious (DePaola & Grant, 2019).
Provide surgical masks to visitors who are coughing and provide the rationale to enforce usage. Instruct visitors to cover mouth and nose (by using the elbows to cover) during coughing or sneezing; use tissues to contain respiratory secretions with immediate disposal to a no-touch receptacle; perform hand hygiene afterward.
Educating visitors on the importance of preventing droplet transmission from themselves to others reduces the risk of infection. Masks that provide coverage of the mouth and nose should be worn at every point of being with the client or during client care. Each client room should be prepared with protective barriers which are changed after each client. Garbage receptacles should be readily available for soiled products as well as common spaces (DePaola & Grant, 2019).
Place the client in protective isolation if the client is at high risk of infection.
Protective isolation is set when the WBC indicates neutropenia. Also called reverse isolation, this is indicated for neutropenic clients. These clients are placed in a single-client room, with an adequate ventilation system, if possible (Mohty et al., 2018).
Initiate specific precautions for suspected agents as determined by CDC protocol.
Standard precautions. The premise of standard precautions is that all clients are colonized or infected with microorganisms, whether or not there are signs and symptoms, and that a uniform level of caution should be used in the care of all clients. The elements of standard precautions include appropriate hand hygiene, the use of PPE, proper handling of client care equipment and linen, environmental control, prevention of injury from sharps devices, and client’s room assignments within healthcare facilities.
- Hand hygiene. Hands should be washed or decontaminated frequently during client care. When hands are visibly dirty or contaminated with biological material from client care, the hands should be washed with soap and water. If hands are not visibly soiled, healthcare providers are strongly encouraged to use alcohol-based. Waterless antiseptic agents for routine hand decontamination..
- Glove use. Gloves should be worn when a healthcare worker has contact with any client secretions or excretions and must be discarded after each client care contact. Gloves provide an effective barrier for hands from the microflora associated with client care.
- Needlestick prevention. Extreme care is essential in all situations in which needles, scalpels, and other sharp objects are handled. Used needles should not be recapped. Instead, they are placed directly into puncture-resistant containers near the place where they are used. Use a one-handed approach if the situation dictates that a needle must be recapped to decrease the likelihood of skin puncture.
- Avoidance of splash and spray. When the healthcare professional is involved in an activity in which the body fluids may be sprayed or splashed, appropriate barriers must be used, such as goggles, a facemask, or a cover gown.
Airborne precautions. These are required for clients with presumed or proven pulmonary TB, varicella, measles, or other airborne pathogens. When hospitalized, clients should be in airborne infection isolation rooms, engineered to provide negative air pressure, rapid turnover of air, and air either highly filtered or exhausted directly to the outside.
The PPEs appropriate for airborne precautions include fit-tested N95 respirators. An airborne infection isolation room or a single-client room is necessary for client placement. The door should be closed at all times and personnel in charge of the client must be restricted to non-susceptible persons. A sign outside the client’s room may be placed to alert everyone who enters the room.\
Droplet precautions. These precautions are used for organisms such as influenza or meningococcus that can be transmitted by close contact with respiratory or pharyngeal secretions. The nurse should wear a facemask within three to six feet of the client.
The PPEs used for droplet precautions include masks and goggles or face shields.
Contact precautions. Contact precautions are used for organisms that are spread by skin-to-skin contact, such as for antibiotic-resistant organisms or C. difficile. Contact precautions are designed to emphasize cautious techniques and the use of barriers for organisms that have serious epidemiological consequences. Hand washing with soap and water works best than alcohol or waterless hand products because spores are resistant to these. Bleach-containing cleaning products are optimal because bleach can kill spores, therefore, frequently touched equipment should be cleaned daily or whenever visibly soiled.
The PPEs used for contact precautions may include gloves and gowns, and dedicated equipment for the client may be provided. Use only soap and water for hand hygiene in clients with C. difficile infection.
Proper Wearing of PPE
Wear personal protective equipment (PPE) properly.
- Gloves. Wear gloves when providing direct care; perform hand hygiene after properly disposing of gloves. Surgical procedure evidence supports using two layers of gloves as an infection prevention technique. Specific gloves offer differing 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 in 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 the least respiratory protection, while National Institute for Occupational Safety and Health (NIOSH) approved respirators offer the most 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 the client transport as much as possible.
Several principles are used to guide the transport of clients requiring transmission-based precautions. Limit transport for essential purposes only, such as diagnostic and therapeutic procedures that cannot be performed in the client’s room. When transporting, use appropriate barriers on the client consistent with the route and risk of transmission. Notify the healthcare personnel in the receiving area of the impending arrival of the client and of the precautions necessary to prevent transmission (Ernstmeyer & Christman, 2019).
Institute enteric precautions as indicated.
Enteric precautions are used when there is the presence or suspected presence of gastrointestinal pathogens such as Clostridium difficile or norovirus. These pathogens are present in feces, therefore 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. Using only soap and water for hand hygiene is recommended than using a hand sanitizer because they are not effective against C. diff. Using a special disinfecting process after client discharge is imperative, and this includes disinfection of the mattress (Ernstmeyer & Christman, 2019).
Place signages on doors of isolation precaution rooms.
Signs must state the type of precaution required for the client and 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 & Doyle, 2015).
Perform appropriate and systematic donning of PPEs.
PPE should be put on just prior to the interaction with the client and should be removed 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. This prevents any potential cross-contamination from blood or body fluids onto forearms and body.
- Apply surgical or N95 mask. Ensure that the fit is secure with no air leaks because a poor-fitting mask is the number one reason for exposure to pathogens for healthcare providers.
- Apply goggles or face shields. These prevent accidental exposure to the eyes, nose, and mouth. Googles can be placed on top of eyeglasses.
- Apply non-sterile gloves over the top of the cuff of the gown. This ensures complete coverage of the skin on the arms for direct client care (Ernstmeyer & Christman, 2019).
Doffing of PPE
- Remove gloves first by grasping the outer edge by the wrist and peel away from the hand. With the bare hand, reach under the second glove and gently peel down off the fingers. Then perform hand hygiene.
- Remove the gown in a manner that does not contaminate clothing. Starting at the neck ties, pull the outer part forward and, turned inward, roll it into a ball and discard it in the appropriate container. Then, perform hand hygiene.
- Remove eye protection or face shield. Arms of goggles and the headband on the face shield are considered clean. Handle these only by the sides. The front of the face shield or goggles is contaminated.
- Remove 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 meaning forward to allow the mask to slip off the face. Then, perform hand hygiene (Ernstmeyer & Christman, 2019).
4. Promoting Surgical Asepsis
The surgical environment is known for its stark appearance and cool temperature. Precautions include adherence to principles of surgical asepsis and strict control of the environment is required. Policies governing this environment address such issues as the health of the staff, the cleanliness of the rooms, the sterility of equipment and surfaces, processes for scrubbing, gowning, and gloving; and the attire.
Perform a thorough surgical scrubbing before a surgical procedure.
Traditionally, all surgeons, surgical assistants, and nurses prepared themselves by scrubbing their hands and arms with antiseptic soap and water. In some institutions, various alcohol-based products or scrub less soaps are used to prepare the client for surgery but are only effective when no gross contaminants are present.
Wear the appropriate PPE for surgical procedures.
Surgical team members wear long-sleeved, sterile gowns and gloves. Head and hair are covered with a cap, and a mask is worn over the nose and mouth to minimize the possibility that bacteria from the upper respiratory tract will enter the wound. During surgery, only personnel who have scrubbed, gloved, and gowned touch sterilized objects.
Prepare the area of the client’s body for the surgical procedure meticulously.
An area of the client’s skin larger than that requiring exposure during the surgery is meticulously cleansed, and an antiseptic solution is applied. Ig hair removal needs to take place and this was unable to be performed before the client arrived in the OR suite, this is done immediately before the procedure with electric clippers to minimize the risk of infection.
Ensure that any articles used are properly disinfected or sterilized before use.
This reduces or eliminates germs. All surgical supplies, instruments, needles, sutures, dressings, gloves, covers, and solutions that may come in contact with the surgical wound or exposed tissues must be sterilized before use. Only personnel who have scrubbed, gloved, and gowned touch sterilized objects.
Avoid touching a sterile object or prevent it from being touched by a non-sterile object.
Sterile objects must only be touched by sterile equipment or sterile gloves. When the sterility of an object is questionable, then the object should be considered non-sterile. Keep the tips of the forceps down during the sterile procedure to prevent fluid from traveling over the entire instrument and potentially contaminating the sterile field (McCutcheon & Doyle, 2015).
Ensure that all sterile items must be placed above waist level.
Keep all sterile equipment and sterile gloves above the waist level because sterile items that are below the waist level, or items held below the waist level, are considered to be nonsterile (McCutcheon & Doyle, 2015).
Always keep the sterile field within sight.
Sterile fields must always be kept in sight throughout the entire sterile procedure to be considered sterile. Never turn back on the sterile field as sterility cannot be guaranteed (McCutcheon & Doyle, 2015). At least a one-ft distance from the sterile field must be maintained to prevent inadvertent contamination.
Take care to avoid contamination when opening sterile equipment.
Items are dispensed to a sterile field by methods that preserve the sterility of the items and the integrity of the sterile field. After a sterile package is opened, the edges are considered unsterile. Sterile supplies, including solutions, are delivered to a sterile field or handed to a scrubbed person in such a way that the sterility of the object or fluid remains intact.
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 o 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 & Christman, 2021).
5. Providing Client and Caregiver Education
Nurses must provide information on proper hygiene, respiratory etiquette, wound care, and the importance of completing prescribed treatments. Client support and counseling are also crucial to address any concerns or anxieties related to the infection and its management.
Educate the client and caregivers about the infectious process.
The nurse’s role is to educate the client and, in some situations, to report the case to public health officials for contact tracing and verification of follow-up. Infectious diseases often seem mysterious and frequently are socially stigmatizing. Client education requires empathy and sensitivity.
Instruct caregivers to obtain accurate temperature readings.
Because fever offers clues about infection severity and the success of antibiotic therapy, outpatients with fever should be instructed to obtain accurate temperature readings. Frequently, family caregivers know that a client has warm skin but do not take a temperature reading. Body temperature information can be very helpful in adjusting therapy or in reevaluating a preliminary diagnosis.
Educate clients and SO (significant other) about appropriate cleaning, disinfecting, and sterilizing items.
Knowledge of ways to reduce or eliminate germs reduces the likelihood of transmission. Cleaning with commercial cleaners that contain soap or detergent decreases the number of germs on surfaces and reduces the risk of infection from these surfaces. Sanitizing reduces the remaining germs on surfaces after cleaning. Disinfecting can kill harmful germs that remain on surfaces after cleaning. Before sanitizing or disinfecting, instruct the client and caregiver to clean surfaces first because impurities like dirt may make it hard for sanitizing or disinfecting chemicals to get to and kill germs (Centers for Disease Control and Prevention, 2022).
Teach the importance of avoiding contact with individuals who have infections or colds. Teach the importance of physical distancing.
Other people can spread infections or colds to a susceptible client (e.g., immunocompromised) through direct contact, contaminated objects, or air currents. During the height of the COVID-19 pandemic, avoiding contact with people who have the virus, whether or not they feel sick, reduced the risk of acquiring the virus from them (Centers for Disease Control and Prevention, 2023).
Demonstrate and allow return demonstration of all high-risk procedures that the client and/or SO will do after discharge, such as dressing changes, peripheral or central IV site care, and so on.
Clients and SO need opportunities to master new skills to reduce susceptibility to infection. Return demonstration of these procedures before discharge helps reinforce the key points for all these functions and ensures that the client and caregiver have adequate knowledge about the implementation of the procedure. This ensures that directions are followed correctly.
Teach the client, family, and caregivers, the purpose and proper technique for maintaining isolation.
Knowledge of isolation can help clients and family members cooperate with specific precautions. Nurses serve important roles in preventing the transfer of organisms as they have many opportunities for spreading organisms, given their frequent encounters with clients and families. It is essential for nurses to model appropriate hygiene practices in all aspects of client care.
If infection occurs, teach the client to take anti-infectives as prescribed. If taking antibiotics, instruct the client to take the full course of antibiotics even if symptoms improve or disappear.
Antibiotics work best when a constant blood level is maintained when medications are taken as prescribed. Not completing the prescribed antibiotic regimen can lead to drug resistance in the pathogen and the reactivation of symptoms. Increasingly, hospitals are adapting antimicrobial stewardship programs to control antimicrobial resistance, improve outcomes, and reduce healthcare costs (Habboush et al., 2023).
Instruct the client and caregivers to remind healthcare workers if seen not adhering to infection control procedures.
The nurse should observe the hand hygiene activities of other professionals and alert them to lapses in technique that are observed. Additionally, nurses need to educate clients and their caregivers to feel comfortable in reminding healthcare workers to perform hand hygiene before client contact.
Provide information about the importance of vaccines and participating in vaccination programs.
The goal of vaccination programs is to use wide-scale efforts to prevent specific infectious diseases from occurring in a population. An annual influenza vaccine is recommended for all people six months or older unless contraindicated. In addition, adults who are immunosuppressed should be vaccinated for pneumococcus and meningococcus. Healthcare workers should be immune to measles, mumps, rubella, pertussis, tetanus, hepatitis B, and varicella. The CDC gives information about individual vaccines and vaccine-preventable diseases.
Educate the client to report any problems encountered after vaccination.
Nurses should ask adult vaccine recipients to provide information about any problems encountered after vaccination. As mandated by law, a Vaccine Adverse Event Reporting System (VAERS) form must be completed with all the necessary information. These forms are obtained by telephone or via the Internet and can be submitted online.
Instruct the caregiver to regularly disinfect all equipment used by and within the immediate surroundings of the client and use an aseptic technique as indicated.
All caregivers must pay careful attention to disinfection and aseptic technique while using medical equipment. Catheter-related sepsis should be suspected in a client who has an unexplained fever, redness, swelling, and drainage around a vascular catheter insertion site. These should be promptly reported to the healthcare provider.
Educate members of the family about strategies to reduce the risk of becoming infected.
Establishing reasonable barriers to infection transmission in the household is an important part of home care. If the client has active PTB, the public health department must be contacted to provide screening and treatment for family members. Maintaining physical separation is an important strategy for immunosuppressed clients and their family members if varicella is present.
Inform the client and caregivers about sharps safety if the client has a blood-borne infection.
Family members who assist in the care of a client with a blood-borne infection such as HIV or hepatitis C can prevent transmission by carefully handling any sharp objects that are contaminated by blood. Family education may include a discussion about the need for caution when shaving the client; performing dressing changes; or administering any IV, intramuscular, or subcutaneous medication. The family should also use containers designed for sharps disposal.
Encourage the client to spend time outdoors and improve ventilation.
Improving ventilation and filtration can help prevent virus particles from accumulating in indoor air. This can help protect the client from getting infected with and spreading the virus that causes COVID-19. Spending time outside when possible instead of inside can also help (Centers for Disease Control and Prevention, 2023).
Recommended nursing diagnosis and nursing care plan books and resources.
Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care
We love this book because of its evidence-based approach to nursing interventions. This care plan handbook uses an easy, three-step system to guide you through client assessment, nursing diagnosis, and care planning. Includes step-by-step instructions showing how to implement care and evaluate outcomes, and help you build skills in diagnostic reasoning and critical thinking.
Nursing Care Plans – Nursing Diagnosis & Intervention (10th Edition)
Includes over two hundred care plans that reflect the most recent evidence-based guidelines. New to this edition are ICNP diagnoses, care plans on LGBTQ health issues, and on electrolytes and acid-base balance.
Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales
Quick-reference tool includes all you need to identify the correct diagnoses for efficient patient care planning. The sixteenth edition includes the most recent nursing diagnoses and interventions and an alphabetized listing of nursing diagnoses covering more than 400 disorders.
Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care
Identify interventions to plan, individualize, and document care for more than 800 diseases and disorders. Only in the Nursing Diagnosis Manual will you find for each diagnosis subjectively and objectively – sample clinical applications, prioritized action/interventions with rationales – a documentation section, and much more!
All-in-One Nursing Care Planning Resource – E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health
Includes over 100 care plans for medical-surgical, maternity/OB, pediatrics, and psychiatric and mental health. Interprofessional “patient problems” focus familiarizes you with how to speak to patients.
Other recommended site resources for this nursing care plan:
- Nursing Care Plans (NCP): Ultimate Guide and Database MUST READ!
Over 150+ nursing care plans for different diseases and conditions. Includes our easy-to-follow guide on how to create nursing care plans from scratch.
- Nursing Diagnosis Guide and List: All You Need to Know to Master Diagnosing
Our comprehensive guide on how to create and write diagnostic labels. Includes detailed nursing care plan guides for common nursing diagnostic labels.
References and Sources
Recommended resources and reading materials for risk for infection nursing diagnosis and care plan:
- Allegranzi, B., & Pittet, D. (2009). Role of hand hygiene in healthcare-associated infection prevention. Journal of hospital infection, 73(4), 305-315.
- Arrowsmith, V. A., Maunder, J. A., & Taylor, R. (2001). Removal of nail polish and finger rings to prevent surgical infection. Cochrane database of systematic reviews, (1).
- Berman, A., Snyder, S. J., Kozier, B., Erb, G. L., Levett-Jones, T., Dwyer, T., … & Parker, B. (2014). Kozier & Erb’s Fundamentals of Nursing Australian Edition (Vol. 3). Pearson Higher Education AU.
- Brusch, J. L., & Stuart, M. (2023, January 26). Urinary Tract Infection (UTI) and Cystitis (Bladder Infection) in Females Workup: Approach Considerations, Urinalysis, Urine Culture. Medscape Reference.
- Calder, P. C., Carr, A. C., Gombart, A. F., & Eggersdorfer, M. (2020). Optimal Nutritional Status for a Well-Functioning Immune System Is an Important Factor to Protect against Viral Infections. Nutrients, 12(4).
- Centers for Disease Control and Prevention. (2020). Medications that Weaken Your Immune System and Fungal Infections | Fungal Infections | Fungal | CDC. Centers for Disease Control and Prevention.
- Centers for Disease Control and Prevention. (2022, November 2). When and How to Clean and Disinfect a Facility | Water, Sanitation, and Environmentally Related Hygiene | CDC. Centers for Disease Control and Prevention.
- Centers for Disease Control and Prevention. (2022). Nail Hygiene | CDC. Centers for Disease Control and Prevention.
- Centers for Disease Control and Prevention. (2023). How to Protect Yourself and Others | CDC. Centers for Disease Control and Prevention.
- Debonera, F., & Simmons, B. B. (2021). Infections in Older Adults: The Art of Early Recognition. Annals of Long-Term Care.
- DePaola, L. G., & Grant, L. E. (2019, November 18). Respiratory Hygiene and Cough Etiquette – PMC. NCBI.
- Ernstmeyer, K., & Christman, E. (2019). Nursing Fundamentals. Open Resources for Nursing.
- Ernstmeyer, K., & Christman, E. (2021). Nursing Skills. Open Resources for Nursing.
- Fairley, J. (2023). General Approach to the Returned Traveler | CDC Yellow Book 2024. CDC.
- Gilmartin, H. M. (2019). Hand Hygiene 101. Centers for Disease Control and Prevention.
- Group, H. L. (1999). Hand washing: a modest measure—with big effects. BMJ: British Medical Journal, 318(7185), 686.
- Guppy, M. P., Mickan, S. M., Del Mar, C. B., Thorning, S., & Rack, A. (2011). Advising patients to increase fluid intake for treating acute respiratory infections. Cochrane Database of Systematic Reviews, (2).
- Habboush, Y., Yarrarapu, S. N. S., & Guzman, N. (2023, March 30). Infection Control – StatPearls. NCBI.
- Hinkle, J. L., & Cheever, K. H. (2018). Brunner & Suddarth’s Textbook of Medical-surgical Nursing. Wolters Kluwer.
- Hussain, Y., & Khan, H. (2022). Immunosuppressive Drugs – PMC. NCBI.
- Ibarra-Coronado, E. G., Pantaleón-Martínez, A. M., Velazquéz-Moctezuma, J., Prospéro-García, O., Méndez-Díaz, M., Pérez-Tapia, M., … & Morales-Montor, J. (2015). The bidirectional relationship between sleep and immunity against infections. Journal of immunology research, 2015.
- Ivanov, A. V., Bartosch, B., & Isaguliants, M. G. (2017). Oxidative stress in infection and consequent disease.
- Jane Ward, D. (2007). Hand adornment and infection control. British journal of nursing, 16(11), 654-656.
- Kening, M. (2023, February 22). Personal Protective Equipment – StatPearls. NCBI.
- Kong, W., & Agarwal, P. P. (2020). Chest imaging appearance of COVID-19 infection. Radiology: Cardiothoracic Imaging, 2(1), e200028.
- Laws, T., & Hillman, E. (2015). Infection prevention and control. Pearson Australia.
- McCutcheon, J. A., & Doyle, G. R. (2015). Clinical Procedures for Safer Patient Care. BC Open Textbook Project.
- Mohty, M., Dufour, C., Kröger, N., & Carreras, E. (Eds.). (2018). The EBMT Handbook: Hematopoietic Stem Cell Transplantation and Cellular Therapies. Springer International Publishing.
- Pae, M., & Wu, D. (2017). Nutritional modulation of age-related changes in the immune system and risk of infection. Nutrition Research, 41.
- Pittet, D. (2000). Improving compliance with hand hygiene in hospitals. Infection Control & Hospital Epidemiology, 21(6), 381-386.
- Price, V. A., Smith, R. A., Douthwaite, S., Thomas, S., Almond, D. S., Miller, A. R., … & Beadsworth, M. B. (2011). General physicians do not take adequate travel histories. Journal of travel medicine, 18(4), 271-274.
- Ragnoli, B., Pochetti, P., Pignatti, P., Barbieri, M., Mondini, L., Ruggero, L., Trotta, L., Montuschi, P., & Malerba, M. (2022, January 14). Sleep Deprivation, Immune Suppression and SARS-CoV-2 Infection. NCBI.
- Reime, M. H., Harris, A., Aksnes, J., & Mikkelsen, J. (2008). The most successful method in teaching nursing students infection control–E-learning or lecture?. Nurse Education Today, 28(7), 798-806.
- Rivers, J. K., Arlette, J. P., DeKoven, J., Guenther, L. C., Muhn, C., Richer, V., Rosen, N., Tremblay, J.-F., Wiseman, M. C., Zip, C., & Zloty, D. (2021, December 8). Skin care and hygiene among healthcare professionals during and after the SARS-CoV-2 pandemic. NCBI.
- Robson MC, Stenberg BD, Heggers JP. Wound healing alterations caused by infection. Clin Plast Surg. 1990;17(3):485-492.
- Rowe, C. (2022, November 14). Histology, White Blood Cell – StatPearls. NCBI.
- Sax, H., Allegranzi, B., Uckay, I., Larson, E., Boyce, J., & Pittet, D. (2007). ‘My five moments for hand hygiene’: a user-centred design approach to understand, train, monitor and report hand hygiene. Journal of Hospital Infection, 67(1), 9-21.
- Smith, D. S., & Basistha, M. (2023, April 18). Bacterial Infections and Pregnancy: Practice Essentials, Overview, Group B Streptococcus. Medscape Reference.
- Tenke, P., Mezei, T., Böde, I., & Köves, B. (2017). Catheter-associated Urinary Tract Infections. European Urology Supplements, 16(4).
- Voss, A., & Widmer, A. F. (1997). No time for handwashing!? Handwashing versus alcoholic rub can we afford 100% compliance?. Infection Control & Hospital Epidemiology, 18(3), 205-208.
- Zimmerman, S., Gruber‐Baldini, A. L., Hebel, J. R., Sloane, P. D., & Magaziner, J. (2002). Nursing home facility risk factors for infection and hospitalization: importance of registered nurse turnover, administration, and social factors. Journal of the American Geriatrics Society, 50(12), 1987-1995.