05-07 Healthcare-Associated Infections

Question 1

1. Recog epidem and med behaviors that give rise to healthcare-assoc infxs

Answer 1

EPIDEMIOLOGY
—Affects 1.7 million pts/yr (1 in 20 hospitalized pts daily!)
—99,000 deaths/yr

MED BEHAVIORS THAT GIVE RISE
—central lines
—folley caths
—ventilators
—providers who are carriers of MRSA, others
—antibiotic usage
—long-hospitalizations

Question 2

2. ID manifestations (i.e. common syndromes) seen in healthcare-assoc infxs

Answer 2

MANIFEST AS TYPICAL SYNDROMES
—Central Line Assoc Bloodstream (CLABSI)
—Cath-assoc UTI (CAUTI)
—Surg sit infx (SSI)
—Vent-assoc events (VAE)
—MRSA
—C diff infx (CDI)

See specific cards

Question 3

3. Review public health impact of HCAI, and the std px measures taken to address them

Answer 3

STANDARD PX MEASURES
—#1 = HAND HYGIENE
—isolation precautions
—req'd immunizations
—anti-microbial stewardship

Question 4

4. Recog the critical role of px in the containment of HCAI

Answer 4

Prevention is critical…duh

Question 5

5. Recog their economic impact

Answer 5

~$30 BILLION dollars a year wasted on HCAI fall-out!

Question 6

6. Describe the role of culture techniques in the dx of HCAIs

Answer 6

not addressed

Question 7

7. ID the role of the MD in px and containment of HCAIs

Answer 7

not addressed

Question 8

Drug of choice for most pre-op prophylaxis…when to give?

Answer 8

cefazolin
—give 1 hr pre-op
—d/c 24 hrs post-op

Question 9

Healthcare work req’d vaccinations

Answer 9

Hep B
Influenza (yearly)
MMR
Varicella
TDaP

Question 10

CLABSI
—Relative mortality
—Usual bugs

Answer 10

CENTRAL LINE-ASSOC BLOODSTREAM INFX
—12-25% mortality and mostly preventable

Usual bugs = cutaneous flora
—Coag-neg staph
—Staph aureus
—Enterococci
—Candida
—Gram negatives (nosocomial)

Question 11

SSI
—Avg incubation
—Typical pathogens
—Risks

Answer 11

SURGICAL SITE INFXS
Average Incubation
—5-7 days
—1-2 days for Rapidly progressive GAS or Clostridial

Typical Pathogens (Endogenous, nosocomial skin flora and qqf airborne)
—S. aures
—Coag neg staph
—Enterics and anaerobes

Risk Factors
—Pt's susceptibility (DM, obese, HIV, age etc)
—Inapp abx proph / shaving
—Prolonged pre-op stay/long-surgery
—Surgeon's skill
—Infections elsewhere

Question 12

VAE
—Mortality
—Bug categories
—Risks

Answer 12

VENTILATOR ASSOC EVENTS (VAP)
Mortality
—6-14%

Bugs
—aspiration of endogen or nosocomial oropharygenal or gastric flora

Risks
—Amt prev abx
—Contaminated vent
—Achlorhydria
—NG
—COPD, age
—Upper abd surg

Question 13

MRSA

—% of pop w/ S. aureus nasal colonization

Answer 13

—MRSA is #2 cause of HAIs

—33% people S.aureus colonized (2% MRSA)

Question 14

CDI
—Epidemiology
—% of abx-related diarrhea?
—Risk Factors
—Sequeale
—Transmission
—Px

Answer 14

C. DIFF
Epidem
—Becoming MORE common
—Only HAI not decr'ing
—Causes ~20% of all abx-related diarrhea

Risk Factors
—Age
—Abx
—Gi srug
—Immunosupp
—PPI usage

Sequelae
—toxic megacolon
—sepsis
—death

Transmission
—by healthcare workers

Preventions
—hand hygiene
—contact precautions
—clean w/ chlorine-containing agents
—use Abx responsibly