Nursing Precautions for Patients at Risk of Opportunistic Infections
Nurses should implement comprehensive infection prevention measures including proper hand hygiene, personal protective equipment, environmental cleaning, and patient-specific precautions based on the type of opportunistic infection risk to reduce morbidity and mortality in vulnerable patients. 1, 2
General Infection Prevention Measures
- Hand hygiene is the cornerstone of infection prevention. Nurses should wash hands thoroughly after contact with patients, bodily fluids, raw meat, soil, or contaminated surfaces 1
- Use personal protective equipment (PPE) including sterile gloves, gowns, and masks when performing invasive procedures or changing dressings, catheters, or tubes 1, 2
- Maintain standard precautions for all patients, with additional isolation measures for specific pathogens as indicated 1, 3
- Implement environmental cleaning protocols to reduce pathogen transmission in healthcare settings 2, 4
Specific Precautions Based on Infection Type
Pneumocystis Carinii Pneumonia (PCP)
- While some authorities recommend not sharing hospital rooms between patients with PCP and those at risk, evidence is insufficient to support this as standard practice 1
- Nurses should follow standard precautions when caring for patients with or at risk for PCP 1
Toxoplasma Infection Prevention
- Educate patients about avoiding raw or undercooked meat, particularly pork, lamb, and venison 1
- Instruct patients to wash hands after contact with raw meat, soil, or after gardening 1
- For patients with cats, advise that litter boxes should be changed daily, preferably by an HIV-negative, non-pregnant person 1
- Teach proper handwashing after changing cat litter if the patient must do it themselves 1
Cryptosporidium Infection Prevention
- Educate patients about transmission routes including contact with infected persons, animals, contaminated water, and food 1
- Advise patients to avoid contact with human and animal feces 1
- Instruct patients to wash hands after changing diapers or handling pets 1
- Advise against recreational activities in potentially contaminated water 1
- Recommend avoiding raw oysters and drinking water directly from lakes or rivers 1
Environmental and Food Safety Precautions
- Ensure patients' food is properly cooked - meat should reach an internal temperature of 73.8°C (165°F) 1
- Advise washing fruits and vegetables thoroughly before eating them raw 1
- Recommend drinking only safe water sources - bottled, filtered, or boiled water may be necessary 1
- For home environments, advise regular cleaning of flat surfaces to eliminate dust and dirt 1
- Recommend avoiding construction or renovation work in the patient's environment, or using FFP3 masks if unavoidable 1
Special Considerations for Healthcare Settings
- Implement antimicrobial stewardship to reduce risk of resistant infections 2
- Consider isolation precautions for patients with transmissible opportunistic infections 3
- Avoid sharing rooms between immunocompromised patients when possible, especially during outbreaks 3
- Maintain proper ventilation in healthcare settings to reduce airborne transmission 3
- Follow safe injection practices and proper handling of medical equipment 2
Medication-Related Precautions
- Monitor patients on trimethoprim-sulfamethoxazole (commonly used for PCP prophylaxis) for adverse effects, particularly in patients with AIDS who may have higher incidence of side effects 5
- Ensure adequate fluid intake for patients on prophylactic medications to prevent crystalluria 5
- Monitor serum potassium in patients on high-dose trimethoprim, especially those with underlying kidney dysfunction 5
By implementing these evidence-based precautions, nurses can significantly reduce the risk of opportunistic infections in vulnerable patients, improving outcomes and quality of life 2, 4.