NORMAL BODY DEFENCES
LECTURER: MISS MABEL AVANE/MISS
FRANCIS ACHALIWIE
Introduction
• In order to care for patients with an infection or
infectious disease, a basic understanding of the
workings of the immune system and the pathogenesis
(development) of infection is advantageous.
• In order to destroy invading pathogens and protect the
host from infection, the immune system has to be able
to differentiate between self and non-self – what is
foreign to the body and what is not.
The body’s defense against infection
• The body defends itself naturally against the
invasion of microorganisms.
• This phenomenon is called The Body’s Defense
Mechanism.
• There are two branches of the immune system
which work both independently of each other and
together:
1. The innate or natural immune response.
2. The adaptive or acquired immune response.
1. The innate, or natural, immune response
• Innate immunity, or natural immunity, is quite simply
the body’s first line of defense; it is always ‘switched
on’ and leaps into action as soon as a pathogen is
detected.
• It is non-specific, meaning that its actions are directed
against any pathogen the first time the pathogen is
encountered.
• If it is breached, it focuses and directs the actions of
adaptive immunity, or the acquired immune response,
but unlike adaptive or acquired immunity, the workings
of the innate immune system do not confer life-long
protection upon the host.
The innate, or natural, immune response cont.
• It consists of physical barriers, internal and external body
surface secretions and cells, all of which are present in the
individual from birth.
The body’s natural barriers
Skin and normal flora
Mucous membranes
Sneezing, coughing, and tearing
Elimination and acidic environment
Inflammation (WBCs).
2. The adaptive, or acquired, immune response
• The adaptive or acquired immune response is uniquely
remarkable for its specificity, diversity and immunologic
memory (the ability to recognize specific antigens and
pathogens when they are next encountered) and can be
divided into humoral (antibody) and cell-mediated
(lymphocyte) responses.
• Its actions are targeted against specific antigens, which
are molecules capable of inducing an immune response and
reacting with antibodies. Examples are bacterial toxins or
bacterial cells, etc
The adaptive, or acquired, immune response cont.
• The first encounter with the antigen generates
a primary response and, following this initial
exposure, a more powerful and rapid response
is generated on encountering the antigen or
pathogen a second time.
Stages of the infectious process
• Incubation period; this is the period between the
entry of the infectious agent in the host and onset of
symptoms. During this time the agent invades tissues
and multiplies to produce an infection. The client is
very infectious to others at the later part of this stage.
• Prodromal period; this is the time from the unset of
non-specific symptoms until specific symptoms
begin to manifest.
Stages of the infectious process Cont’d
• Illness stage; this is stage when the client
shows specific signs and symptoms of the
infection.
• Convalescent stage; from the beginning of the
disappearance of acute symptoms until the
client returns to the previous state of health
(recovery stage).
The inflammatory process
• When the body suffers a traumatic injury, or is invaded
by microorganisms, it generates an inflammatory
response, which is designed to localise the infection
and limit its spread. The physiological events that
subsequently take place give rise to the cardinal signs
of infection, or inflammation:
• Redness or erythema (rubour)
• Heat (calour)
• Swelling (tumour)
• Pain (dolour)
• Loss of function.
Inflammatory process cont.
• Vasodilation (widening of the blood vessels) occurs at
the site of ‘injury’. This results in an increased blood
flow, which contains plasma proteins, neutrophils and
phagocytes, to the affected site.
• The temperature of the skin rises as a result of the
increased blood supply and an increase in the metabolic
activities in the cells of the tissues at the damaged site.
• The capillaries that line the epithelial cells dilate,
releasing plasma which causes swelling; depending on
the site involved and the severity of the swelling, this
may lead to pain and loss of function.
Inflammatory process cont.
• Once the invading bacteria have been dealt with, the
damaged tissues and cells begin the process of repair.
• However, if the immune response has been weak
and/or the infection is overwhelming, an inflammatory
exudate forms at the site of inflammation, consisting
of fluid, cells and cellular debris known as pus, often
seen in wound infections and the host may die.
CHAIN OF INFECTION
Introduction
• The ‘chain of infection’ is the phrase used to describe the process
by which infection can spread from one susceptible individual to
another.
• For an infection to occur, all the links in the chain must be intact
and in the correct order. In order to break the chain, it is important
that healthcare workers understand how the different components
of the chain interact and facilitate the spread of infection.
• Then, the basic principles of infection prevention and control
(standard aseptic precautions) can be applied to clinical practice to
break the chain.
The Chain of infection
1. Causative organism/agent
•This is an organism or agent that is capable of
causing a disease or an infection.
Examples of causative agents;
–Biological agents; bacteria, viruses, etc
–Chemical agents; poisons, pollutants, etc
–Physical agents; radiation, allergens, etc
The Chain of infection cont.
2. Reservoir – the place where the agent can survive to
colonize and reproduce.
• Organic material such as dirt, blood and body fluids can
harbour bacteria and viruses, and any equipment that has
been in contact with the patient can serve as both a reservoir
and a source of infection.
• Infected patients, bed frames, mattresses and manual
handling equipment have all been implicated in the spread of
infection.
The chain of infection cont.
• 3. Portal of exit - route by which infectious agents leave reservoir to be transferred
to susceptible host.
• 5. Portal of entry - contact point where transmission of agent occurs.
• These include the respiratory and gastro-intestinal tracts and the skin and mucosa,
with organisms carried in blood and body fluids, in respiratory droplets and on the
surface of the skin.
• In some organisms, the portal of exit can be the same as the portal of entry, such as the
respiratory tract in tuberculosis, or it may be different; in Salmonella infections where
the route of entry is the mouth as Salmonella has to be ingested, and the exit route is in
the faeces.
The chain of infection cont.
4. Mode of transmission
This refers to the way in which the organism is spread and acquired.
Contact transmission - physical transfer of agent e.g. touch, sex, etc.
Airborne transmission - contamination suspended in air e.g. sneezing,
coughing, etc.
Vehicle transmission - agent transferred via inanimate object e.g. cups,
spoons, etc.
Vector borne transmission - agent transferred through animals or insects
e.g. mosquito bite.
The chain of infection cont.
6. The susceptible patient.
• This is person who is at risk of becoming
infected with a certain disease due to a variety
of reasons.
Factors that increase the risk of infection
• Age
• Nutritional status
• Loss of mobility
• Co-existing illness or disease
• Immunocompromised as a result of underlying
illness or treatment
• Medication
• The presence of invasive indwelling devices
• Duration of hospital stay
Breaking the chain of infection
• Between agent and reservoir
– Cleansing
– Disinfection
– Sterilization
Breaking the chain of infection cont.
• Between reservoir and portal of exit
– Proper hygiene
– Clean dressings
– Clean linen
– Clean equipment
Breaking the chain of infection cont.
• Between portal of exit and mode of
transmission.
Block exit of infectious agent by:
Proper hand hygiene after handling contaminated items.
Covering mouth when sneezing and coughing
Wearing gloves
NOSOCOMIAL INFECTIONS
Infection is acquired in a health care facility and
was not present at the time of admission.
• This is a very serious problem that has to be
prevented at all cost.
• The way to prevent infections in a health care
facility is by employing the Standard Precautions
of asepsis.
General factors contributing to hospital acquired infections
• Increase in the number of patients undergoing major
surgery and invasive diagnostic procedures.
• An increasing elderly population with weakened
immunity and increased susceptibility to infection.
• Hospitals no longer able to cope with the patient
population – design, layout, condition and maintenance
of buildings and environment.
• Increased bed occupancy rates.
• Increased patient turnaround times.
• Increased movement of patients.
General factors contributing to hospital acquired infections
cont.
• Lack of isolation facilities
• Use of invasive indwelling devices
• Lack of equipment
• Contaminated equipment and devices
• Length of stay
• Antibiotic resistance
• Poor antimicrobial prescription
• Poor infection control practice
• Poor clinical leadership
• Poor staff-to-patient ratios
• Poor staff morale.
Standard precautions
Also known as universal precautions or standard
principles; are steps taken to prevent infection
transmission in a health care setting. The techniques are:
Hand hygiene.
The use of personal protective equipment (PPE) and
clothing .
The safe handling and disposal of sharps.
Cleaning and decontamination of equipment and the
environment.
The proper handling and disposal of healthcare waste.
The proper handling and disposal of linen and laundry.
The management of blood and body fluid spillages.
THANK YOU