Risk Factors for Infection
The risk of infection arises when the body’s natural defenses are compromised, leaving individuals vulnerable to pathogenic organisms. Patients with weakened immune systems or disrupted defense mechanisms require meticulous nursing care and preventive strategies. Several factors can heighten the risk of infection:
- Compromised Physical Defense Mechanisms: Breaks in the skin, whether from injuries, surgical procedures, or invasive interventions, provide entry points for pathogens. Conditions affecting peristalsis, fluid stasis, or mucous membrane integrity also weaken the body’s defenses.
- Immunosuppression or Immune Impairment: Conditions or medications that suppress the immune response significantly increase infection risk. Chronic diseases and malnutrition can also impair the body’s ability to combat infections.
- Knowledge Deficit Regarding Infection Prevention: Insufficient understanding of hygiene practices and high-risk behaviors, such as unprotected sexual activity, can elevate an individual’s susceptibility to infection.
Important Note: A risk diagnosis is based on potential problems and not on existing signs and symptoms. Nursing interventions are crucial for preventing the infection from occurring.
Expected Outcomes
The primary goals for a “risk for infection” nursing diagnosis are to prevent infection development and empower patients through education. Desired patient outcomes include:
- Absence of infection, indicated by stable vital signs and the absence of infection markers like swelling, redness, or purulent drainage in compromised skin areas.
- Verbalization of understanding regarding hygiene and behavioral measures for infection prevention.
- Recognition and reporting of infection signs requiring healthcare provider intervention.
Nursing Assessment
A thorough nursing assessment is fundamental to identifying and addressing the risk of infection. This involves gathering subjective and objective data related to the patient’s condition and risk factors.
1. Identify Existing Risk Factors, Injuries, or Treatments:
- Wounds, abrasions, or surgical sites: These compromise skin integrity, creating potential infection portals.
- Invasive lines (IVs, catheters, drains, intubation): These devices bypass natural defenses and can introduce pathogens.
Image alt text: Close-up of an IV insertion site on a patient’s arm, showing a transparent dressing effectively covering the insertion point to prevent infection.
2. Medication Review for Immunosuppressants:
- Antineoplastic agents and Corticosteroids: These medications are known to suppress the immune system, increasing vulnerability to infections.
3. Monitor for Signs of Infection:
- Elevated white blood cell count: Often indicates the body’s response to infection.
- Fever: A common systemic sign of infection.
- Redness, swelling, purulent drainage: Local signs of infection in areas of skin compromise.
- Changes in urine or sputum: Can indicate urinary tract or respiratory infections.
4. Nutritional Status Assessment:
- Weight, serum albumin, and nutritional status: Malnutrition weakens the immune system and increases infection susceptibility.
5. Hygiene Practice Evaluation:
- Hand hygiene, bathing, and oral care: Inadequate hygiene practices are significant risk factors for infection.
6. Vaccination Status Review:
- Up-to-date vaccinations: Lack of recommended vaccinations increases the risk of vaccine-preventable infections, especially in individuals with other risk factors.
Nursing Interventions
Effective nursing interventions are critical in mitigating the risk of infection and promoting patient well-being.
1. Implement Aseptic Technique and Hand Hygiene:
- Hand washing before and after patient contact.
- Aseptic technique for procedures involving non-intact skin or invasive lines: IV insertion and maintenance, catheter insertion and care, central and PICC line dressing changes, and wound care.
Image alt text: Nurse demonstrating proper handwashing technique at a hospital sink, emphasizing the importance of hand hygiene in preventing infection spread in healthcare settings.
2. Consider Limiting Visitors and Protective Isolation:
- Limit visitors: Reduces exposure to potential pathogens.
- Protective isolation: Implement for severely immunocompromised patients to provide an extra layer of protection.
3. Patient and Caregiver Education:
- Teach signs and symptoms of infection: Empower patients and families to recognize early infection indicators.
- Educate on when to contact a healthcare provider: Ensure timely medical intervention if infection is suspected.
- Wound care instructions: Crucial for patients discharged with wounds requiring ongoing care.
4. Nutritional Support:
- Encourage intake of calorie and protein-rich foods: Adequate nutrition strengthens the immune system.
5. Proper Use of Personal Protective Equipment (PPE):
- Educate patients on mask use: Especially in high-risk environments.
- Ensure diligent PPE use by the care team: Protect immunocompromised patients from pathogen exposure.
Nursing Care Plans
Nursing care plans for “risk for infection” should be tailored to the patient’s specific risk factors and guide appropriate interventions. Conditions associated with increased infection risk include:
- Chronic illnesses
- Immunosuppression
- Invasive procedures
- Decreased hemoglobin
- Leukopenia
- Open wounds
- Malnutrition
- Rupture of amniotic membranes
- Antibiotic therapy
- Altered pH of mucous secretions
Care plans facilitate prioritized assessments and interventions, guiding both short-term and long-term care goals.
Care Plan Example #1
Diagnostic Statement:
Risk for infection related to diminished immune response.
Expected Outcomes:
- Patient will articulate understanding of infection risk.
- Patient will demonstrate preventive measures against infection.
Assessment:
1. Determine Underlying Cause of Immunosuppression:
Identify pre-existing conditions (e.g., neoplasm, autoimmune disorder, diabetes, liver or kidney failure) or treatments (steroid use, chemotherapy, radiotherapy) that compromise immune function.
2. Monitor and Report Signs of Infection:
Assess for fever, redness, purulent discharge, and other infection indicators. Early detection enables prompt treatment and sepsis prevention. Be vigilant for sepsis indicators such as altered mental status, fever, chills, and hypotension.
3. Review Laboratory Values:
Elevated WBC count may suggest infection. However, patients with neutropenia or consistently low WBC counts who develop fever require immediate medical attention due to their compromised ability to fight infection, which can rapidly progress to sepsis.
Interventions:
1. Protective Isolation for High-Risk Patients:
Implement protective isolation for patients with severe neutropenia (WBC count below 500-1000/mm3). Adhere to institutional protocols for protective isolation.
2. Limit Visitors:
Restrict visitation to minimize infection transmission risk. If visitors are permitted, ensure they use appropriate PPE.
3. Strict Hand Hygiene and Glove Use:
Practice diligent hand hygiene. Use gloves appropriately to reduce hand contamination and discard after each patient interaction. Wash hands immediately after glove removal.
4. Patient and Family Education on Hand Hygiene:
Educate patients and families about proper handwashing techniques, emphasizing its role as a primary defense against healthcare-associated infections (HAIs).
Care Plan Example #2
Diagnostic Statement:
Risk for infection related to invasive procedure and surgical incision.
Expected Outcomes:
- Patient will achieve timely wound healing.
- Patient will remain free from surgical site infection.
Assessment:
1. Monitor for Surgical Wound Infection Signs:
Assess for foul-smelling purulent discharge, surgical site pain, warmth, swelling, or redness. Promptly report any signs of surgical site infection to the healthcare team.
2. Assess Patient and Family Knowledge of Infection Precautions:
Evaluate understanding of infection prevention measures, including hand hygiene, as knowledge promotes proactive health behaviors.
3. Obtain Specimens for Culture and Sensitivity:
Collect tissue or fluid specimens for culture and sensitivity testing to identify the causative pathogen and guide antibiotic selection for surgical site infections.
Interventions:
1. Administer Antimicrobials as Prescribed:
Administer antibiotics as indicated, monitoring therapy response and potential side effects. Prophylactic antibiotics are often given pre-incision and continued for up to 24 hours post-surgery, though protocols may vary.
2. Educate on Proper Wound Care Techniques:
Instruct patients and families on proper wound care for daily cleaning and debris removal. Key techniques include:
- Handwashing before and after wound care.
- Maintaining sterile technique during dressing changes.
- Daily dressing changes.
- Application of topical medications as directed.
For patients discharged with dressings, emphasize infection signs and when to contact their physician.
3. Promote Protein and Calorie-Rich Diet:
Encourage optimal nutritional intake to bolster immune function and wound healing.
4. Educate on Surgical Wound Infection Risk Factors:
Inform patients about personal risk factors for impaired wound healing to facilitate proactive prevention strategies.
References
- Ackley, B.J., Ladwig, G.B.,& Makic, M.B.F. (2017). Nursing diagnosis handbook: An evidence-based guide to planning care (11th ed.). Elsevier.
- Branch-Elliman, W., O’Brien, W, Strymish, J., Itani, K., Wyatt, C.,& Gupta, K. (2019). Association of duration and type of surgical prophylaxis with antimicrobial-associated adverse Events. JAMA Surg, 154(7), 590–598. doi:10.1001/jamasurg.2019.0569
- Carpenito, L.J. (2013). Nursing diagnosis: Application to clinical practice (14th ed.). Lippincott Williams & Wilkins.
- Doenges, M.E., Moorhouse, M.F., & Murr, A.C. (2019). Nursing care plans Guidelines for individualizing client care across the life span (10th ed.). F.A. Davis Company.
- Gulanick, M. & Myers, J.L. (2014). Nursing care plans Diagnoses, interventions, and outcomes (8th ed.). Elsevier.
- Herdman, T. Heather, and Shigemi Kamitsuru. Nursing Diagnoses: Definitions and Classification 2018-2020. Thieme, 2018.
- Hobani, F.& Alhalal, E. (2022). Factors related to parents’ adherence to childhood immunization. BMC Public Health, 22, 819. https://doi.org/10.1186/s12889-022-13232-7
