Bioterrorism and IVDA BSIs Flashcards
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
Infectious disease disasters
Why are infectious disease disasters different from other types of disasters?
Increase risk of communicable disease spread during and after the incident
Principles of emergency management
- mitigation
- preparedness
- response
- Recovery
Characteristics of bioterrorism agents
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
Most likely release of bioterrorist agent
Aerosol
Methods of dissemination biological agents
- Aerosol
- oral
- percutaneous
- infected animal vector
- human to human
the intentional use of a biological agent or derivative of such an agent to inflect harm or death onto a civilian population
Bioterrorism
Intentional use of biological agent that targets military personnel
Biological warfare
Is bioterrorism preparedness a requirement?
Yes, required by healthcare and public health regulatory agencies
What do healthcare and public health regulating agencies require for bioterrorism preparedness?
Comprehensive emergency management progran
What does the potential impact of bioterrorism depend on?
1) agent used
2) amount disseminated
3) Dispersal method
4) weather/ release conditions
5) preexisting immunity
6) how quickly attack id’d
Category of agent that poses the highest risk to national security
Category A
Describe category A
- easily disseminated or transmitted from person- person
- high mortality
- cause public panic and social disruption
- require special preparedness actions
Category A agents
- Anthrax
- Botulism
- Plague
- Smallpox
- Tularemia
- Viral hemorrhagic fevers
Category: Anthrax
A
Category: Botulism
A
Category plague
A
Category Smallpox
A
Category tularemia
A
Category viral hemorrhagic fever
A
category of agents that pose the second highest risk to national security
Category B
Describe category B agents
- moderately easy to disseminate
- low mortality rates
- require enhancement of diagnostic and surveillance capability
Category B agents
- WNV
- Caliciviruses
- Hep A
- Ricin toxin
- Salmonella
- Diarrheagenic E. Coli
Category WNV
B
Category calicivirus
B
Category Hep A
B
Category Ricin
B
Category Salmonella
B
Category diarrhea e. coli
B
Category of bioterrorism agents that are emerging pathogens that could be engineered for mass dissemination
Category C
Describe category C agents
- Available
- Easily produced and disseminated
- Potential for high mortality rates
Examples of category C agents
- Influenza
- SARS
- Rabies
- MDR TB
- Yellow fever
- Tickborne hemorrhagic fever
Category Influenza
C
Category SARS
C
Category Rabies
C
Category MDR TB
C
Category Yellow Fever
C
Category tickborne hemorrhagic fever
C
Pandemic phase 1
Low risk of human cases
Pandemic phase 2
Higher risk of human cases
Pandemic phase 3
No or very limited human-to human transmission
Pandemic phase 4
Evidence of increased human-human transmission
Pandemic phase 5
Evidence of significant human-human transmission
Pandemic phase 6
Efficient and sustained human- human transmission
What phases does the inter-pandemic phase include?
phase 1 and 2 (new virus in animals, no human cases)
What phases does the pandemic alert include?
Phases 3-4- new virus causes human cases
What phases does the pandemic include?
Phase 5-6 (Significant Human- human transmission)
Q fever category
b
What are the two major sources of intravascular device- associated bloodstream infections?
1) colonization of the IV device (catheter associated infection)
2) contamination of the fluid administered through the device (Infusate-associated infection)
What is the cause of most epidemic intravascular device associated bloodstream infections?
Contaminated infusate
What is the cause of most endemic intravascular device associated bloodstream infections?
Catheter-associated infections
When obtaining blood cultures to guide antimicrobial therapy, what IP practices are important?
1) attention to skin disinfection
2) Collection of adequate amount of blood
3) careful handling of specimen
Recent studies have shown that consistent application of high-yield preventative ________ can lead to substantial and sustained reductions in facility rates of CLABSIs
Bundles
What are some examples of novel technologies to prevent CLABSIs?
1) Anti-infective catheters
2) Antiseptic dressings
3) antibiotic lock solutions
What must happen first for a microorganism to cause a CLABSI?
must gain access to the extraluminal or intraluminal surface of the device
What happens when a microorganism adheres to a catheter?
Produce and become incorporated into a biofilm
What are the 3 mechanisms for microorganisms to gain access to the bloodstream?
1) skin organisms invade percutaneous tract
2) Microorganisms contaminate the catheter hub
3) organisms carried hematogenously to implanted ivd from remote sources
When do CLABSIs with skin organisms occur?
at time of insertion or days following
When do microorganisms contaminate the catheter hub or lumen?
when the catheter is inserted over a percutaneous guidewire or later manipulated
prevention measure for skin organisms causing CLABSIs?
CHG, skin antisepsis
Prevention for microorganisms contaminating the catheter hub
scrub the hub
How long are short term IVDs in place?
<10 days
Examples of Short-term IVDs
1) peripheral intravenous (IV) catheters
2) Arterial catheters
3) noncuffed, nontunneled CVCs
What causes most short-term device associated BSIs?
cutaneous microorganisms from insertion site that gain access extraluminally
How long are long term IVDs in place?
> 10 days
Examples of long-term IVDs?
1) cuffed Hickman and Broviac type catheters
- subcutaneous central ports
- PICCs
Predominant mode of BSI for long-term IVDs
contamination of the catheter hub and luminal fluid
What are infusates that are administered through IVDs?
1) parenteral fluid
2) Blood products
3) IV medications
Are contaminated infusates a common cause of endemic infusion-associated infection with most short-term IVDs?
No
What is the most common bacteria (gram stain and shape) associated with epidemics of infusion associated BSI?
Gram-negative bacilli
When an infusate is contaminated and the contaminant was introduced during its manufacture
Intrinsic contamination
When an infusate is contaminated and the contaminant was introduced during it’s preparation and administration in the healthcare setting
Extrinsic contamination
top 3 pathogens most commonly isolated from intravascular devices?
1) Coagulase- negative staph (31%)
2) Staph aureus (18%)
3) Enteric gram-negative bacilli
If these species are recovered from multiple cultures, it is strongly suggestive of an IVD infection
- Staph
- Corynebacterium or bacillus
- candida
- malassezia
How many blood cultures should be obtained when there is an IVD? where from?
2 separate sites
@ least 1 drawn from peripheral vein by percutaneous venipuncture
What are strategies to prevent IVDA BSIs?
1) Choice of catheter and site of device insertion
2) Barrier precautions
3) Intravenous teams
4) cutaneous antisepsis
What is the lowest risk site for IVD insertion to prevent BSIs?
Subclavian vein insertion
What is the highest risk insertion site for CLABSIs?
Femoral vein insertion
What insertion sites for CLABSIs pose intermediate risk?
Jugular vein insertions
How often is it recommended to replace central venous catheters?
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
What is a central line?
Catheter inserted into a large vein close to the heart (Superior vena cava or inferior vena cava)
Sites for insertion of central line
1) Internal jugular vein, terminates in SVC
2) Subclavian- terminates in SVC
3) Femoral (emergency)- terminates in IVC
Where is the subclavian vein
Under collar bone
Why have a central line for meds
Can administer meds that are irritants or vesicants
multiple infusions
PICC description
Peripherally Inserted Central Catheter
Basilic vein in arm, terminates in SVC
Less prone to infection
Describe tunneled lines
-inserted through skin
- access vein under skin
-cuff to hold in place
- less risk of infection
- often used for patients going home with device
Describe a port
- similar to tunneled
- Access hub under skin
- tunneled into vein
- chemo patients
Hemodialysis line description
- Larger lumens, faster flow
- Temporary
- red and blue end or pigtail access
Two types of central lines
General- single, double. triple lumens
-specialty: introducer, sheath, MAC (larger lumen, faster flow)
Central line care: line patency
Flush line and check blood return (not always able), use push pause manuever
Can you draw cultures from the central line?
No, peripheral sticks because may have line colonization
What to do if suspecting infected central line?
Remove or replace line
Care for dressing/ site: when to change the dressing
- Border coming up
- or every 7 days
If guaze present, change in 24 hours
PPE for central line dressing changes
- sterile gloves
- mask
Skin prep for central line dressing changes
- CHG prep
What type of dressing to use for central line?
Antimicrobial patch that is the correct size (impregnated with CHG)
Line Care
- 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
How often to change pressure caps
Every 72 hours- 96 hours
Describe central line insertion
- typically bedside
- new, clean line
- sterile procedure
PPE for central line insertion
- cap and mask for everyone
- inserter fully sterile
- Sterile drape
Prep for Central Line insertion
CHG prep
