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Ash's Certification Study > Chain of Infection, Risk Factors, Immune System, Immunocompromised Host > Flashcards

Chain of Infection, Risk Factors, Immune System, Immunocompromised Host Flashcards

1
Q

Immune response that does not involve antibodies but rather involves the activation of macrophages and NK cells, the production of antigen specific cytotoxic t lymphocytes, and the release of various cytokines in the response to an antigen

A

Cell Mediated Immunity

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2
Q

An aspect of specific immune responses directed at particular antigens it takes the form of unique antibodies produced by B lymphocytes that have been specifically selected to neutralize the antigen at hand.

A

Humoral Immune response

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3
Q

Types of T cells

A

Cytotoxic t cells- CD8
Helper T-cells- CD4

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4
Q

Types of B cells

A

Plasma and memory cells

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5
Q

Substances such as interferon, interleukin, and growth factors which are secreted by certain cells of the immune system and have an effect on other cells

A

Cytokines

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6
Q

Where are secretory antibodies present in the body?

A

Oral secretions, tears, intestinal contents, breast milk, prostate, and the female reproductive system

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7
Q

Glycoprotein molecules produced by the plasma cells that recognize and bind to antigens and aid in their destruction

A

immunoglobulins

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8
Q

Late occurring in a meeting response and longest lived because it enters interstitial tissue relatively easily it is the major antibody to protect tissue

A

IgG

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9
Q

First reacting immunoglobulin and an adaptive immune response to an infection and is generally produced for no more than 6 months after the onset of infection

A

IgM

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10
Q

Principal’s secretory antibody and humans primarily produced in plasma cells residing in mucous membranes. Effective in preventing viral infections of respiratory tract and intestinal mucosa

A

IgA

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11
Q

Present principally on the surface of lymphocytes and it serves to bind specific antigens. Functions in later immune responses

A

IgD

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12
Q

Principal allergy inducing immunoglobulin known as reagin

A

IgE

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13
Q

Portals of entry for opportunistic pathogens

A

Skin
Lungs
Oropharynx
GI tract of neutropenic host

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14
Q

What illnesses are there passive IM or IV immunoglobulin available for?

A

Hepatitis A
Hepatitis B
Tetanus
Rabies
Varicella

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15
Q

IVIG is not generally recommended for the following patients…

A

Routine oncology patients

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16
Q

Rarely appropriate but may be used in very select patients (chemo or bone marrow transplants with bacterial or fungal infection that doesn’t respond to antimicrobials

A

Granulocyte transfusions

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17
Q

Secreted glycoproteins that bind to receptor proteins on the surfaces of hematopetic stem cells thereby activating intracellular signaling pathways that can cause the cells to proliferate and differentiate into white blood cells

A

Colony stimulating factors

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18
Q

When would colony stimulating factors be used?

A

Chemo patients with neutropenia

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19
Q

Chain of transmission

A
  1. Infectious agent
  2. Reservoir
  3. Portal of exit
  4. Mode of transmission
  5. Portal of entry
  6. Susceptible host
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20
Q

Virulence

A

Ability to grow and multiply

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21
Q

Infectivity

A

Ability to enter tissue

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22
Q

Pathogenicity

A

Ability to cause disease

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23
Q

Duration of exposure

A

Length of time person exposed to organism

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24
Q

Size of innoculm

A

Number of organisms needed to cause disease

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25
Q

High risk procedures for HAIs

A
  1. IV access and central lines
  2. Mechanical ventilation
  3. Indwelling urinary catheters
  4. Hemodialysis
  5. Parenteral nutrition
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26
Q

Infection versus colonization

A

Colonization, shows on culture but no signs or symptoms

Infection - tissue damage and disease, signs and symptoms

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27
Q

Toxin that is mostly Gram + organisms, proteins that are secreted from the cell

A

Exotoxin

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28
Q

Toxin that is highly antigenic and has vax

A

Exotoxin

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29
Q

Toxin that has high toxicity

A

Exotoxin

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30
Q

Toxin that is heat liable

A

Exotoxin

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31
Q

Toxin that is mostly gram negative

A

endotoxin

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32
Q

Toxin from LPS, released when bacterial cell is killed

A

endotoxin

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33
Q

toxin that is not highly antigenic

A

endotoxin

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34
Q

toxin that is heat stable

A

Endotoxin

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35
Q

toxin that has low toxicity

A

Endotoxin

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36
Q

Examples of the exotoxin

A

cholera
Tetanus
Botulism

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37
Q

Examples of endotoxins

A

Meningococcemia
Sepsis

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38
Q
  1. Ability to Survive in env between hosts
  2. Mechanism for transmission to new host
  3. Ability to attach to a new host, invade, and disseminate
A

Factors for virulence

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39
Q

Endogenous opportunistic organism in lungs

A

Mycobacterium tuberculosis
Coccidioides immitis
Histoplasma
Pneumocystis jirovechii

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40
Q

Endogenous opportunistic organisms in skin

A

Coagulase negative staph
Corynebacteria
Maleassezia furfur
HSV and herpes zoster

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41
Q

Endogenous opportunistic organisms in GI tract

A

Enterococcus
Streptococcus bovis
Clostridium septicum
Candida spp
Bacterioides fragilis

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42
Q

Endogenous opportunistic organism in oropharynx

A

Candida spp

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43
Q

Endogenous opportunistic organism in central nervous system

A

Toxoplasma gondi

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44
Q

Exoogenous opportunistic organism on hands/ fomites

A

Clostridium difficile
Viruses other than herpes

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45
Q

Exogenous opportunistic organisms in water

A

Legionella
Cryptosporidium

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46
Q

Exogenous opportunistic organism in environment

A

Zygomycetes (fungi in rotten wood that cause rare pulmonary disease)
Rapidly growing mycobacteria (fortuitum chealonae)

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47
Q

Exogenous opportunistic organism in ventilation during construction

A

Aspergillus

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48
Q

Opportunists that can be either endogenous or exogenous

A
  1. Aerobic gram negative bacilli (endogenous from oropharynx and gi tract, exogenous from contaminated food or fomites)
  2. Staph aureus
    Endogenous on skin and in nasal carriage, exogenous from personnell hands
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49
Q

What medical interventions increase risk?

A
  1. Presence of invasive devices
  2. Placement in an ICU
  3. Exposure to antibiotics or certain medications
  4. Immunosuppressive therapy
  5. Length of hospitalization
  6. Staffing ratios
  7. Experience in training of care provider for certain device- associated infections
  8. Increase number of hcp examinations / procedures
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50
Q

Name 3 examples of patient factors that increase risk of transmission

A
  • Immunosuppressive diseases and disorders
  • malignant disorders
  • patient Apache score
  • poor nutritional status
  • age
  • diabetes
  • pregnancy
  • travel history
  • occupation
  • residence
  • contact with certain pets of animals
  • extensive burn wounds
  • trauma
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51
Q

What bacteria typically cause bacterial meningitis?

A

Streptococcus pneumoniae
Neisseria meningitidis
Haemophilus influenzae
Streptococcus agalactiae
Listeria monocytogenes

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52
Q

What bacteria typically cause otitis media?

A

Streptococcus pneumoniae

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53
Q

What bacteria typically cause community acquired pneumonia?

A

Streptococcus pneumoniae
Haemophilus influenzae
Staphylococcus aureus

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54
Q

What types of bacteria typically cause atypical pneumonia?

A

Mycoplasma pneumoniae
Chlamydia pneumoniae
Legionella neumophilia

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55
Q

What bacteria causes tuberculosis pneumonia?

A

Mycobacterium tuberculosis

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56
Q

What type of bacteria typically cause skin infections?

A

Staphylococcus aureus
Streptococcus pyogenes
Pseudomonas aeruginosa

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57
Q

What type of bacteria typically cause sexually transmitted diseases?

A

Chlamydia trachomatis
Neisseria gonorrheae
Treponema pallidum
Ureaplasma urealyticum
Haemophilus ducreyi

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58
Q

What type of bacterial infections typically cause eye infections?

A

Staphylococcus aureus
Neisseria gonorrhea
Chlamydia trachomatis

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59
Q

What type of bacterial infections typically cause sinusitis?

A

Streptococcus pneumoniae
Haemophilus influenzae

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60
Q

What bacterial infections typically cause upper respiratory tract infections

A

Streptococcus pyogenes
Haemophilus influenzae

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61
Q

What type of bacterial infections typically cause gastritis

A

Helicobacter pylori

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62
Q

What type of bacteria typically cause food poisoning?

A

Campylobacter jejuni
Salmonella
Shigella
Clostridium
Staphylococcus aureus
E coli

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63
Q

What type of bacterial infections usually cause UTIs

A

E coli
Other enterobacteriaceae
Staphylococcus saprophyticus
Pseudomonas aeruginosa

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64
Q

Examples of communicable diseases when hcp should be restricted?

A

Diarrhea
Group a strep
Conjunctivitis
Draining dermatitis
Exudative lesions
Active tuberculosis
Infectious rashes

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65
Q

What are some personnel practices that are important for infection prevention?

A
  1. Immunization
  2. Restriction of hcp with a communicable disease
  3. Assignment of patients to be careful by immune HCPs
  4. Protocol for evaluation and follow-up of employee exposure to infectious diseases
66
Q

How long can staphylococcus aureus including MRSA survive in the environment?

A

7 days to over 12 months

67
Q

How long can C diff survive in the environment?

A

Over 5 months

68
Q

How long can norovirus survive in the environment?

A

8 hours to over 2 weeks

69
Q

Immune compromised patients include only…

A
  1. Neutropenia (neutrophil count < 500
  2. Leukemia, lymphoma, or HIV positive with a CD4 count <200
  3. Splenectomy
  4. History of solid organ or hematopetic stem cell transplant
  5. Cytotoxic chemotherapy
  6. On enteral or parenteral steroids daily for >14 days
70
Q

Describe management of the immunocompromised host

A
  1. Recognize host effects that are associated with impaired resistance
  2. Knowledge of the type of infection to anticipate in each category of immune compromise
  3. Most common portals of entry for opportunistic organisms
  4. Fact that clinical manifestations of illness may be different in the immunocompromised host
  5. Understanding of the broad array of modality for infection prevention
71
Q

How do clinical manifestations differ for neutropenic patients

A

They have little perulance at the site of infection and less obvious chest radiographic findings

72
Q

How do clinical manifestations differ for patients receiving corticosteroids

A

Diminished or absent fever response

73
Q

What are the two most common pathogens for burn victims?

A

Staphylococcus aureus
Pseudomonas aeruginosa

74
Q

What are the reasons that nasotracheal or orotracheal intubation can contribute to healthcare associated pneumonia?

A
  • Blockage of sinus drainage
  • Mechanical trauma to mucosa
  • Impaired swallowing of secretions
  • Adherence of bacteria to foreign body
  • Pulling of secretions around the cuff
  • Mucosal ischemia around the cuff
  • Impaired ciliary clearance and cough
75
Q

In___ patients, the gastrointestinal tract is often the most important source for bacteremia

A

Neutropenic

76
Q

How long is someone with a recent bone marrow transplant considered immunocompromised?

A

6 months

77
Q

List of common opportunistic bacterial infections associated with cell-mediated immunity dysfunction

A
  • Listeria monocytogenes
  • Salmonella spp
  • Mycobacterium spp, including M tuberculosis
  • Nocardia
  • legionella pneumophila
  • rhodococcus equi
  • pseudomonas pseudomallei
78
Q

Most common opportunistic infections associated with breaks in cutaneous integrity

A
  • staph aureus
  • strep pyogenes
  • corynebacteria (diabetics)
  • maleassezia furfur (lipid IV)
79
Q

Opportunistic infections associated with defects in mucous membranes

A

Anaerobic bacteria
- bacteroides fragilis
- clostridium perfringens
- c. Septicum

Aerobic bacteria
- gram - bacilli

Candida spp

Enterococcus spp

Streptococcus bovis

80
Q

Opportunistic infections associated with obstruction of the lungs

A

Oral Flora
Nosocomial gram-negative
Staphylococcus aureus

81
Q

Opportunistic infection that result from obstruction of a natural body passage in the biliary and pancreatic systems

A

Aerobic gram-negative bacilli
Enterococcus
Anaerobes

82
Q

Most common opportunistic infections associated with obstruction of a natural body passage specifically the colon

A

Gram negative bacilli
Anaerobes
Streptococcus bovis

83
Q

Opportunistic infections associated with granulocytopenia for 2 weeks or less

A

Gram negative bacilli
Staphylococcus aureus
Coagulase negative staphylococcus

84
Q

Absolute neutrophil count of 500 ml

A

Granulocytopenia

85
Q

Opportunistic infections associated with Granulocytopenia for more than 2 weeks

A

Gram negative bacilli
Staphylococcus aureus
Coagulase negative staphylococcus
Candida spp
T glabrata
Aspergillus spp

86
Q

Fungal opportunistic infections associated with dysfunction of cell-mediated immunity

A

Cryptococcus neoformans
Candida spp
Coccidioides y
Histoplasma calsulatum
Penicillium marnwffej
Pneumocystis jirovechi

87
Q

Opportunistic viral infections associated with cell mediated immunity dysfunction

A

Herpes group virus especially cytomeglovirus
Herpes zoster

88
Q

Opportunistic protozoa associated with cell-mediated immunity dysfunction

A

Toxoplasma Gondii
Cryptosporidium spp

89
Q

Opportunistic helminths associated with cell mediated immunity dysfunction

A

Strongyloides stercoalis

90
Q

Opportunistic infections associated with splenectomy or humoral dysfunction

A

Encapsulated bacteria
- streptococcus pneumoniae
- encapsulated strains of Haemophilus influenzae
- Neisseria meningitidis

91
Q

Describe mycobacteria cell wall

A

Mycolic acid (cord factor), waxy surface impervious to chemicals or dyes

92
Q

How to break the chain: susceptible host

A

Immunizations
Treatment underlying disease
Health insurance
Patient education

93
Q

Any person, especially those receiving healthcare

A

Susceptible host

94
Q

Part of chain - bacteria, fungus, viruses, parasites

A

Infectious agent

95
Q

How to break the chain infectious agent

A

Dx and treatment
Antimicrobial stewardship

96
Q

Chain of infection- dirty surfaces and equipment, people, water, animals and insects soil

A

Reservoir

97
Q

How to break the chain reservoir

A

Cleaning, disinfection, sterilization
Infection prevention policies
Pest control

98
Q

Chain: open wounds, skin, splatter body fluids, aerosols

A

Portal of exit

99
Q

How to break the chain portal of exit

A

Hand hygiene
PPE
Control of aerosols and splatter
Respiratory etiquette
Waste disposal

100
Q

Chain: contact (direct or indirect), ingestion, inhalation

A

Mode of transmission

101
Q

How to break the chain: mode of transmission

A

Hand hygiene
PPE
Food safety
Cleaning, disinfection, sterilization
Isolation

102
Q

Chain: broken skin, incisions, resp tract, mucous membranes, catheters and tubes

A

Portal of entry

103
Q

How to break the chain portal of entry

A

Hand hygiene
PPE
Personal hygiene
First aid
Removal of catheters ans tubes

104
Q

Presence of invasive devices
Placement in ICU
Exposure to antibiotics or certain meds
Immunosuppressive therapy
Length of hospitalization
Staffing ratio
Experience and training of hcp
Increased number of hcp examinations/ procedures

A

Medical interventions that increase risk

105
Q

Immunosuppressive diseases
Malignant disorders
Apache score
Poor nutrition
Age
Diabetes
Pregnant
Travel history occupation
Residence
Contact with certain pets
Extensive burn wounds
Trauma

A

Patient factors that increase risk of transmission

106
Q

How far for large droplets travel

A

1-3 ft

107
Q

How far do droplet nuclei travel?

A

6-150+ feet

108
Q

How far do small droplets travel?

A

3-6 ft

109
Q

Personnel practices

A

1) immunization
2) restriction of hcp that are sick
3) Assignments to immune HCPs
4) Protocols for exposures

110
Q

Occurs when microbes inhabit a specific body site but don’t cause signs and symptoms

A

Colonization

111
Q

Clinical signs of illness or inflammation due to tissue damage cause by microbe invasion

A

Infection

112
Q

Measure of a microbes ability to invade and create disease in a host

A

Virulence

113
Q

Initial element of virulence

A

Ability of an organism to survive in the external environment during Transit between hosts

114
Q

What is the second element of virulence

A

Mechanism for transmission to a new host

115
Q

Proteins produced inside pathogenic bacteria, most commonly gram-positive bacteria, as part of their growth and metabolism. They are then secreted or released into the surrounding medium following lysis

A

Exotoxin

116
Q

Lipid portions of lipopolysaccharides that are part of the outer membrane of the cell wall of gram-negative bacteria. They are liberated when the bacteria die and the cell wall breaks apart

A

Endotoxins

117
Q

Part of immune system that is Induced, mediated, a regulated by t lymphocytes and mononuclear phagocytes

A

Cell mediated immune system

118
Q

Part of immune system that gains of the ability to recognize virus infected cells and adhere to and kill them

A

Antibody mediated humoral immune system

119
Q

Cells that are part of the antibody mediated humoral immune system

A

CD4
Cd8 (cytotoxic or suppressive)
B cells

120
Q

Substances that have specific structures and biological activities

A

Cytokines

121
Q

True or false, patients may have more than 1 type of immunocompromise

A

True

122
Q

Thorough _____ and detailed physical exam often reveal potential problems of the immunocompromised host

A

History taking

123
Q

What are the most important precautions for the immunocompromised host?

A

Standard precautions and transmission based precautions when indicated

124
Q

Nhsn classification of immunocompromised

A

Neutropenia
Leukemia
Lymphoma
HIV positive with CD4 count less than 200
Splenectomy
Solid organ transplants
Hematopoietic stem cell transplant
Cytotoxic chemotherapy
Enteral or parenteral administered steroids

125
Q

Comprehensive management of immunocompromised host

A

Recognition of categories of host defects that are associated with impaired resistance

Knowledge of the type of infection to anticipate in each category of immune compromise

The most common portals of entry for opportunistic organisms

The fact that clinical manifestations of illness may be different in the immuno compromised host

And understanding of the broad array of modalities for prevention of infection

126
Q

True or false: most patients have abnormalities that may wax or wane with time and therapy

A

True

127
Q

Is determined by the interaction of several variables including host defense defects caused by the disease process, the type of immunological abnormality induced by a specific agent, the dose duration and temporal sequence of immunosuppressive therapy, the presense or absence of neutropenia and or lymphopenia, the state of humoral and cellular host defenses, the integrity of the skin and mucosal surfaces of the body, metabolic factors, abnormalities of the reticular endothelial system most notably the spleen, and the presence or absence of immunomodulating infections such as HIV hepatitis etc

A

Net state of immunosuppression

128
Q

Categories of host effects associated with impaired resistance- what causes defects in the cutaneous barrier

A
  1. Surgical incisions
  2. Thermal or chemical burn
  3. Traumatic injuries to the skin
  4. Severe dermatologic conditions
  5. Indwelling IV lines
  6. Injections
  7. Ulcers
129
Q

What are some of the severe dermatological conditions that can cause defects in the cutaneous barrier?

A

Poorly controlled eczema or psoriasis
Scleroderma
Mycosis fungoides
Chronic fungal infections of the skin or nail beds

130
Q

What causes mucous membrane barrier defects

A
  1. Mucositis from chemo
  2. Trauma to the head and neck
  3. Smoking
  4. Inhalation injuries
  5. Poor oral hygiene
  6. Erosions from nasogastric or endotracheal tubes or indwelling Foley catheters
  7. Antacids, proton pump inhibitors, etc
131
Q

Why do antacids and proton pump inhibitors impact the mucous membrane

A

They decrease the number of ingested organisms necessary to cause GI disease and they allow a reservoir for bacteria to develop in the stomach which can be regurgitated and aspirated

132
Q

Part of immune system that is born ready, ready to immediately act

A

innate immune system

133
Q

Physical barriers of immune system

A

Skin
mucous membranes

134
Q

Chemical barriers of immune system

A

Lysozyme
Sweat
Stomach acid

135
Q

Role of complement immune system

A

When triggered, chemicals punch holes in membrane

136
Q

signs of inflammation

A

red
hot
swollen
Painful

137
Q

histamine leukocytes

A

basophils

138
Q

Role of basophils

A

Release mast

139
Q

leukocytes that fight parasites (ie helminths)

A

eosinophils

140
Q

common leukocyte that use bleach and peroxide to kill invaders

A

neutrophils

141
Q

dendritic leukocytes that eat invaders and present their antigens

A

macrophages

142
Q

Where are all leukocytes produced?

A

Bone marrow

143
Q

This arm of the immune system is always ready to learn and remember, it requires activation and responds to specific pathogens and forms memory cells

A

Adaptive immune response

144
Q

How are helper t-cells activated?

A

antigen presenting cells

145
Q

What is the role of helper T cells?

A

create memory t cells and activate cytotoxic T cells and B cells

146
Q

What is the role of cytotoxic t cells?

A

kill pathogens

147
Q

What is the role of B cells?

A

Create memory B-cells and plasma B cells create antibodies

148
Q

a chemical messenger that mediates communication between immune cells

A

Cytokine

149
Q

type of cytokine that is produced rapidly after infection and is secreted by lymphocytes and other cell types

A

Interleukin

150
Q

Cytokine that stimulate growth, differentiation, and movement of t and b cells, and they are pro-inflammatory and anti-inflammatory

A

Interleukins

151
Q

What is pus made of?

A

Neutrophils

152
Q

type of cell that kills unhealthy human cells (trigger apoptosis)

A

Natural killer cells

153
Q

How does the inflammatory response work?

A

Mast cells signal the release of histamine, attract macrophages and neutrophils

154
Q

Bind pathogenic cells together to make clumps for phagocytes to eat

A

agglutination

155
Q

Use of surveillance- how to decrease SSI

A

surgeon specific SSI data

156
Q

Use of surveillance to decrease HAIs- how to decrease UTI

A

Unit specific UTI data

157
Q

Is it okay to cohort two people with the same organism if there are no underlying conditions?

A

Yes

158
Q

What are considerations to make before cohorting?

A

Ongoing exposure
increased HAI with non permanent staff
no new admits with the infected pts

159
Q

What are important patient education topics?

A

Hand hygiene
Sharps safety
Germ transmission
Preventing inadvertant contamination
Infection symtpoms
Resp ett.
breathing/ coughing post sugery
Proper pt care

160
Q

Education for visitors

A

Where are visitors allowed?
Post precautions for visitors in high-risk areas
Teach respiratory ett.
teach hand hygiene
Provide warning for exclusion of ill visitors

Ash's Certification Study (22 decks)

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