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Ash's Certification Study > Bioterrorism and IVDA BSIs > Flashcards

Bioterrorism and IVDA BSIs Flashcards

1
Q

Events that involve a biological agent/ disease and result in mass casualties, such as a bioterrorism attach, a pandemic, or an outbreak of an emerging infectious disease

A

Infectious disease disasters

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2
Q

Why are infectious disease disasters different from other types of disasters?

A

Increase risk of communicable disease spread during and after the incident

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3
Q

Principles of emergency management

A
  • mitigation
  • preparedness
  • response
  • Recovery
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4
Q

Characteristics of bioterrorism agents

A

1) ability to be dispersed in aerosols (1-5 microns)

2) Ability to deliver aerosols with simple technology

3) feasibility of agents to infect large numbers of the population if delivered upwind

4) ability to spread infection, disease, panic, and fear

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5
Q

Most likely release of bioterrorist agent

A

Aerosol

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6
Q

Methods of dissemination biological agents

A
  • Aerosol
  • oral
  • percutaneous
  • infected animal vector
  • human to human
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7
Q

the intentional use of a biological agent or derivative of such an agent to inflect harm or death onto a civilian population

A

Bioterrorism

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8
Q

Intentional use of biological agent that targets military personnel

A

Biological warfare

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9
Q

Is bioterrorism preparedness a requirement?

A

Yes, required by healthcare and public health regulatory agencies

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10
Q

What do healthcare and public health regulating agencies require for bioterrorism preparedness?

A

Comprehensive emergency management progran

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11
Q

What does the potential impact of bioterrorism depend on?

A

1) agent used
2) amount disseminated
3) Dispersal method
4) weather/ release conditions
5) preexisting immunity
6) how quickly attack id’d

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12
Q

Category of agent that poses the highest risk to national security

A

Category A

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13
Q

Describe category A

A
  • easily disseminated or transmitted from person- person
  • high mortality
  • cause public panic and social disruption
  • require special preparedness actions
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14
Q

Category A agents

A
  • Anthrax
  • Botulism
  • Plague
  • Smallpox
  • Tularemia
  • Viral hemorrhagic fevers
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15
Q

Category: Anthrax

A

A

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16
Q

Category: Botulism

A

A

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17
Q

Category plague

A

A

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18
Q

Category Smallpox

A

A

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19
Q

Category tularemia

A

A

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20
Q

Category viral hemorrhagic fever

A

A

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21
Q

category of agents that pose the second highest risk to national security

A

Category B

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22
Q

Describe category B agents

A
  • moderately easy to disseminate
  • low mortality rates
  • require enhancement of diagnostic and surveillance capability
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23
Q

Category B agents

A
  • WNV
  • Caliciviruses
  • Hep A
  • Ricin toxin
  • Salmonella
  • Diarrheagenic E. Coli
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24
Q

Category WNV

A

B

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25
Q

Category calicivirus

A

B

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26
Q

Category Hep A

A

B

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27
Q

Category Ricin

A

B

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28
Q

Category Salmonella

A

B

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29
Q

Category diarrhea e. coli

A

B

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30
Q

Category of bioterrorism agents that are emerging pathogens that could be engineered for mass dissemination

A

Category C

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31
Q

Describe category C agents

A
  • Available
  • Easily produced and disseminated
  • Potential for high mortality rates
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32
Q

Examples of category C agents

A
  • Influenza
  • SARS
  • Rabies
  • MDR TB
  • Yellow fever
  • Tickborne hemorrhagic fever
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33
Q

Category Influenza

A

C

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34
Q

Category SARS

A

C

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35
Q

Category Rabies

A

C

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36
Q

Category MDR TB

A

C

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37
Q

Category Yellow Fever

A

C

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38
Q

Category tickborne hemorrhagic fever

A

C

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39
Q

Pandemic phase 1

A

Low risk of human cases

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40
Q

Pandemic phase 2

A

Higher risk of human cases

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41
Q

Pandemic phase 3

A

No or very limited human-to human transmission

42
Q

Pandemic phase 4

A

Evidence of increased human-human transmission

43
Q

Pandemic phase 5

A

Evidence of significant human-human transmission

44
Q

Pandemic phase 6

A

Efficient and sustained human- human transmission

45
Q

What phases does the inter-pandemic phase include?

A

phase 1 and 2 (new virus in animals, no human cases)

46
Q

What phases does the pandemic alert include?

A

Phases 3-4- new virus causes human cases

47
Q

What phases does the pandemic include?

A

Phase 5-6 (Significant Human- human transmission)

48
Q

Q fever category

A

b

49
Q

What are the two major sources of intravascular device- associated bloodstream infections?

A

1) colonization of the IV device (catheter associated infection)

2) contamination of the fluid administered through the device (Infusate-associated infection)

50
Q

What is the cause of most epidemic intravascular device associated bloodstream infections?

A

Contaminated infusate

51
Q

What is the cause of most endemic intravascular device associated bloodstream infections?

A

Catheter-associated infections

52
Q

When obtaining blood cultures to guide antimicrobial therapy, what IP practices are important?

A

1) attention to skin disinfection
2) Collection of adequate amount of blood
3) careful handling of specimen

53
Q

Recent studies have shown that consistent application of high-yield preventative ________ can lead to substantial and sustained reductions in facility rates of CLABSIs

A

Bundles

54
Q

What are some examples of novel technologies to prevent CLABSIs?

A

1) Anti-infective catheters
2) Antiseptic dressings
3) antibiotic lock solutions

55
Q

What must happen first for a microorganism to cause a CLABSI?

A

must gain access to the extraluminal or intraluminal surface of the device

56
Q

What happens when a microorganism adheres to a catheter?

A

Produce and become incorporated into a biofilm

57
Q

What are the 3 mechanisms for microorganisms to gain access to the bloodstream?

A

1) skin organisms invade percutaneous tract
2) Microorganisms contaminate the catheter hub
3) organisms carried hematogenously to implanted ivd from remote sources

58
Q

When do CLABSIs with skin organisms occur?

A

at time of insertion or days following

59
Q

When do microorganisms contaminate the catheter hub or lumen?

A

when the catheter is inserted over a percutaneous guidewire or later manipulated

60
Q

prevention measure for skin organisms causing CLABSIs?

A

CHG, skin antisepsis

61
Q

Prevention for microorganisms contaminating the catheter hub

A

scrub the hub

62
Q

How long are short term IVDs in place?

A

<10 days

63
Q

Examples of Short-term IVDs

A

1) peripheral intravenous (IV) catheters
2) Arterial catheters
3) noncuffed, nontunneled CVCs

64
Q

What causes most short-term device associated BSIs?

A

cutaneous microorganisms from insertion site that gain access extraluminally

65
Q

How long are long term IVDs in place?

A

> 10 days

66
Q

Examples of long-term IVDs?

A

1) cuffed Hickman and Broviac type catheters
- subcutaneous central ports
- PICCs

67
Q

Predominant mode of BSI for long-term IVDs

A

contamination of the catheter hub and luminal fluid

68
Q

What are infusates that are administered through IVDs?

A

1) parenteral fluid
2) Blood products
3) IV medications

69
Q

Are contaminated infusates a common cause of endemic infusion-associated infection with most short-term IVDs?

A

No

70
Q

What is the most common bacteria (gram stain and shape) associated with epidemics of infusion associated BSI?

A

Gram-negative bacilli

71
Q

When an infusate is contaminated and the contaminant was introduced during its manufacture

A

Intrinsic contamination

72
Q

When an infusate is contaminated and the contaminant was introduced during it’s preparation and administration in the healthcare setting

A

Extrinsic contamination

73
Q

top 3 pathogens most commonly isolated from intravascular devices?

A

1) Coagulase- negative staph (31%)
2) Staph aureus (18%)
3) Enteric gram-negative bacilli

74
Q

If these species are recovered from multiple cultures, it is strongly suggestive of an IVD infection

A
  • Staph
  • Corynebacterium or bacillus
  • candida
  • malassezia
75
Q

How many blood cultures should be obtained when there is an IVD? where from?

A

2 separate sites

@ least 1 drawn from peripheral vein by percutaneous venipuncture

76
Q

What are strategies to prevent IVDA BSIs?

A

1) Choice of catheter and site of device insertion
2) Barrier precautions
3) Intravenous teams
4) cutaneous antisepsis

77
Q

What is the lowest risk site for IVD insertion to prevent BSIs?

A

Subclavian vein insertion

78
Q

What is the highest risk insertion site for CLABSIs?

A

Femoral vein insertion

79
Q

What insertion sites for CLABSIs pose intermediate risk?

A

Jugular vein insertions

80
Q

How often is it recommended to replace central venous catheters?

A

Only when indicated

  • remove promptly when no longer deemed necessary
  • inspect insertion site daily for signs of infection and change or remove when catheter insertion site infection is suspected
81
Q

What is a central line?

A

Catheter inserted into a large vein close to the heart (Superior vena cava or inferior vena cava)

82
Q

Sites for insertion of central line

A

1) Internal jugular vein, terminates in SVC
2) Subclavian- terminates in SVC
3) Femoral (emergency)- terminates in IVC

83
Q

Where is the subclavian vein

A

Under collar bone

84
Q

Why have a central line for meds

A

Can administer meds that are irritants or vesicants

multiple infusions

85
Q

PICC description

A

Peripherally Inserted Central Catheter

Basilic vein in arm, terminates in SVC
Less prone to infection

86
Q

Describe tunneled lines

A

-inserted through skin
- access vein under skin
-cuff to hold in place
- less risk of infection
- often used for patients going home with device

87
Q

Describe a port

A
  • similar to tunneled
  • Access hub under skin
  • tunneled into vein
  • chemo patients
88
Q

Hemodialysis line description

A
  • Larger lumens, faster flow
  • Temporary
  • red and blue end or pigtail access
89
Q

Two types of central lines

A

General- single, double. triple lumens

-specialty: introducer, sheath, MAC (larger lumen, faster flow)

90
Q

Central line care: line patency

A

Flush line and check blood return (not always able), use push pause manuever

91
Q

Can you draw cultures from the central line?

A

No, peripheral sticks because may have line colonization

92
Q

What to do if suspecting infected central line?

A

Remove or replace line

93
Q

Care for dressing/ site: when to change the dressing

A
  • Border coming up
  • or every 7 days
    If guaze present, change in 24 hours
94
Q

PPE for central line dressing changes

A
  • sterile gloves
  • mask
95
Q

Skin prep for central line dressing changes

A
  • CHG prep
96
Q

What type of dressing to use for central line?

A

Antimicrobial patch that is the correct size (impregnated with CHG)

97
Q

Line Care

A
  • minimize access to tubing and central line
  • Curos caps (sit on top of open port), but still need to scrub for 15 seconds with alcohol or CHG
  • Keep pressure caps to prevent blood backflow
98
Q

How often to change pressure caps

A

Every 72 hours- 96 hours

99
Q

Describe central line insertion

A
  • typically bedside
  • new, clean line
  • sterile procedure
100
Q

PPE for central line insertion

A
  • cap and mask for everyone
  • inserter fully sterile
  • Sterile drape
101
Q

Prep for Central Line insertion

A

CHG prep

Ash's Certification Study (22 decks)

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