CIC: To Review Flashcards
Bacteria/ Viral/ Fungi/ TB: Opening pressure in CSF analysis
Bacteria: Elevated
Virus: Usually normal
Fungi: variable
TB: Variable
Bacteria/ Viral/ Fungi/ TB: Glucose e in CSF analysis
Bacteria: normal to decreased
Virus: usually normal
Fungi: Low
TB: Variable
Bacteria/ Viral/ Fungi/ TB: Predominate inflammatory cell in CSF analysis
Bacteria: Neutrophils (early or partially treated may have lymphocyte predominance)
Virus: Lymphocytes
Fungi: Lymphocytes
TB: Lymphocytes
Bacteria/ Viral/ Fungi/ TB: WBC Counts in CSF analysis
Bacteria: >=1000/mm^3
Virus: <100/ mm^3
Fungi: variable
TB: variable
Bacteria/ Viral/ Fungi/ TB: Total protein in CSF analysis
Bacteria: Elevated
Virus: Normal to elevated
Fungi: elevated
TB: elevated
Bacteria/ Viral/ Fungi/ TB: Staining in CSF analysis
Bacteria: Gram stain shows gram positive or gram negative
Virus: Gram stain negative
Fungi: India ink, positive
TB: AFB stain positive
Urgent threats
1) carbepenem resistant acinotobacter
2) candida auris
3) clostridioides difficile
4) carbepenem-resistant enterobacterales
5) drug-resistant Neisseria gnorrhoaea
Serious threats
-drug resistant campylobacter
-drug resistant candida
-esbl producing enterobacterales
-vancomycin resistant enterococci
-multidrug resistant pseudomonas aeruginosa
- drug resistant salmonella (both non typhi and typhi)
- drug resistant shigella
-mrsa
- drug resistant strep pneumonia
- drug resistant TB
Concerning threats
Erythromycin resistant GAS
Clindamycin resistant group B strep
Describe high temp sterilization
Steam (apprx. 40 min) or dry heat (1-6 hours depending on temp). Use for heat-tolerant critical surgical items
What is the modified toluidine blue stain used for?
Resp tract parasites and fungi
Ex) pneumocystis jerovecii
What is the trichrome stain used for?
Cysts, trophozites, parasites in stool
What is the wright gimesa stain used for?
Parasites in blood
What organisms is the beta lactamase test used for?
Strep and pseudomonas
What is the disk approximation test used for?
Clindamycin resistance in staph
Types virulence factors
- Adhesins
- exoenzymes
- toxins
- ability for antigenic variation
Steps of pathogenesis
1) exposure
2) adhesion
3) invasion
4) infection (multiplication)
Purpose of glycocalx
Facilitates attachment of bacteria to plastic devices and interferes with penetration of water soluble antibiotics
What organisms causes most ssi within 24 hours?
Strep pyogenes
Types of granulocytes
Neutrophils
Basophils
Eosinophils
Prophylactic antibiotic for pneumocystis jerovecii
Tmp/smx
Endogenous opportunistic organisms of the lungs
M TB
Coccidioides
Histoplasma
Pneumocystis jerovecii
Endogenous opportunistic agents that infect the skin
Staph aureus
Coagulase negative staph
Maladsezia furfur
HSV
Herpes zoster
Endogenous opportunistic organisms that infect the GI tract
Enterococcus
Streptococcus bovis
Colostrum septicum
Candida
Aerobic gram negatives
Endogenous opportunistic organisms that infects the CNS
Toxoplasma gondii
Examples of exogenous opportunistic organisms from hands of hcp
Gram negative
Staph aureus
C diff
Viruses
Examples of exogenous opportunistic organisms from water
Legionella
Crypyosporidium
Examples of exogenous opportunistic organisms from soil, dust, and env
Rhodococcus
Aspergillus
Zygomycetes
NTM
Do endospores in Bacillus spp. and Lactobacillus spp. stain?
No
Spirochetes
Treponema, Boirrelia, Leptospira
Are gram stains effective for spirochetes?
Not usually, but may be detected by darkfield flourescent microscopy
Stain for Cryptococcus neoformans in CSF
India ink
Stain for parasites in stool, including giardia, entamoeba, and endolimax
Trichrome
CSF: Predominant cell neturophil
Bacterial meningitis
CSF: predominant cell lymphocyte
Viral meningitis
CSF: predominant cell eisoinophil
Parasite or fungal meningitis (ie coccidioides)
Classic indicators of bacterial meningitis
Increased WBC
Increased protein
Decreased glucose
What CSF typically looks like for TB meningitis
lymphocytes
low glucose
Which is preferred for lower respiratory culture: bronchoscopy or sputum sample?
Bronchoscopy, such as BAL
Less or more sensitive: POC tests for Group A strep and fly
less sensitive
When are surveillance cultures for staff appropriate?
Not routinely, only when staff implicated in cluster/ outbreak
Types of antibody tests
EIA
Chromogenic immunoassay
Hemagglutination
Latex agglutination
Fluorescent antibody tests
Western Blot
Sensitivity and specificity for HCV RNA
Good sensitivity and specificity
Specificity of urine legionella EIA/ fluorescent antibody test
100% and also has good sensitivity
How reliable are tests for histo, coccidioides, and blastomyces?
High cross-reactivity with other fungi/ poor test reliability
Describe RPR
Screening test for syphilis, high sensitivity, so need confirmatory testing if positive
Specimen Collection Guidelines
1) Use standard precautions for collecting and handling all clinical specimens
2) Use appropriate collection devices
3) Use sterile equipment and aseptic technique
4) Collect specimens during acute phase of the illness (or within 2-3 days for viruses)
5) Collect specimens before administration of antibiotics whenever possible
6) Avoid contamination with indigenous flora from surrounding tissues, organs, or secretions
7) Optimized the capture of anaerobic bacteria from specimens by using proper procedures
8) Collect sufficient volume of specimen to ensure that all tests requested may be performed
9) Proper label: pt name, source, specific site, date, time of collection, and initials of collector
10) Provide clear/ specific instructions on proper collection technique to patients getting their own sample
Specimen Transport Guidelines
1) transport promptly to lab (preferably within 2 hours of collection)
2) Transport in container designed to ensure survival or suspected agents
3) Label properly, package, and protect during transport. Can use transport medium to preserve viability of microbes
4) leak-proof specimen containers and transport in sealable, leak-proof plastic bags
5) Never transport syringes with needles attacched
6) labs must have enforceable criteria to reject unsuitable specimens
What samples should NEVER be refrigerated?
CSF, genital, eye, inner ear
Common transport media
Stuart, amies, carey-blair
Common blood culture contaminants
S. epidermindis
Bacillus spp.
Propionbacterium
S. viridans
Modes of action of antimicrobials
- interfere with cell wall synthesis
- inhibit protein synthesis
- interfere with nucleic acid synthesis
- inhibit metabolic pathway
Leukocytosis (>10,000 WBC) is a sign of
Acute infection
Leukopenia (<4000 WBC) is a sign of
Overwhelming infection:
AIDS
viral hepatitis
Mononucleosis
Legionairre’s disease
Neutrophilia (increase) is a sign of
Inflammation
Bacterial infection
Neutropenia is a sign of
Overwhelming bacterial infections
viral infections (hep, flu)
What diseases cause an increase in basophils?
TB
Smallpox
Chickenpox
Influenza
What diseases cause an increase in monocytes?
- Bacterial infections
TB
Subacute bacterial endocarditis
syphillis
Diseases that cause lymphocytosis (increased >4000)
Infectious mononucleosis
Viral URI
CMV
Measles
Mumps
Chickenpox
Viral Hepatitis
Describe sensitivity
Good sensitivity - Detect sick people
High sensitivity: false positives, confirmatory testing needed
Low - more false negatives
Where are each of the following endemic:
Histpplasma capsulatum
Blastomyces dermatidis
Coccidioides immitis
Histo: Mississippi and Ohio River Valley
Blasto: acidic soil, “”
Coccidioidies: Southwest/ south and central CA
Describe specificity
Good specificity: Health people test negative
High specificity: more false negative, miss some cases
Low specificity: more false positives
What can cold agglutination tests detect?
- mycoplasma pneumo
- mono
- viral pneumo
Diseases with positive C-reactive protein
Meningitis
Pneumonia
Sepsis
TB
What does LAL (Limulus amebocyte lysate) test for?
Endotoxins
Organisms with endotoxins
- E coli
- Salmonella
- Shigella
- Pseudomonas
- Neisseria
- H. influenzae
- B. pertussis
- V. cholera
What organisms with the weil-felix agglutination test detect?
Rickettsia illnesses:
RMSF
Q Fever
Typhus
Rickettisal pox
How do antibiotics work?
- interfere with cell wall biosynthesis
- inhibit bacterial ribosomes
- interfere with DNA replication or RNA transcription
- inhibit metabolic pathways
Pharmacokinetic description for antibiotics
Best pharmodynamic parameters for beta-lactam drugs
Time > MIC
Drug of choice for susceptible enterococcus and Listeria
Aminopenicillins
What bacteria does pipercillin/ tazobactam (zosyn) cover, and what type of antibiotic is it?
Beta-lacatam (penicillin + beta-lactamase inhibitor)
Used as empiric in combination with vanco
Covers Gram + and pseudomonas
Cephalexin
Cefazolin
1st gen cephalosporin
Cefotelan
Cefoxitin
Cefuroxime
2nd gen cephalosporin
Ceftriaxone
Cefotaxime
Cefdinar
Ceftazidime
3rd gen cephalosporin (increasing gram - activity)
cefepime
4th gen cephalosporin (still covers some gram + (strep) and good coverage for gram -, pseudo,
Ceftraoline
5th gen cephalosporin
MRSA and Pseudomonas
Best pharmadynamic for fluoroquinolones
AUC: MIC
Best pharmadynamic for aminoglycosides
Cmax/ MIC
Carbepenems effective against
gram -
Fluoroquinolone examples
Ciprofloxacin
Levofloxacin
What is are fluoroquinolones used for?
gram negative
mechanism of fluoroquinolones
Inhibit bacterial enzymes
Describe tetracyclines
Static
Inhibit protein synthesis at the ribosome
Describe aminoglycosides
Inhibit protein synthesis
cidal
Combo drug for serious gram - MDROs
Examples of aminoglycocides
Amikacin
Gentamicin
Describe macrolides
Static
Inhibit protein synthesis
less serious infections
Examples of macrolides
Ezithromycin
Azithromycin
Clarithromycin
How does TMP-SMX (bactrim) work? What group does it belong to? What is it effective against?
interfere with bacterial folic acid synthesis
sulfanimide
UTI/ oral option MRSA/ Nocardia
Examples tetracyclines
tetracycline
monocycline
Doxycycline
Describe glycopeptides
Vancomycin
concentration dependent (AUC)
MRSA coverage, Staph, Strep, Enterococci
Acts at site of cell wall
Describe use of Linezolid uses
Gram +
Static- oral MRSA but not BSI
Activity against vancomycin resistant bugs
Describe daptomycin uses
Gram + cocci (but not strep)
cidal
vancomycin resistant bugs
Acts at cell membrane
Clindamycin uses
Think above the belt
Mostly gram +
static
Metronidazole uses
Think below the belt
Anaerobes, mostly gram negative
What is rifampin used for?
N. meningitidis
TB
What does successful antimicrobial therapy depend on?
BUG: virulence and susceptibility of the organism
DRUG: activity of the antimicrobial at site of infection
HOST: immunocompromise of host
SITE: body site of infection
What are oral options for MRSA?
Clindamycin, Doxycycline, TMP-SMX, and Linezolid
Bacterial resistance mechanisms
Efflux pumps
Enzyme
Alteration of target site:
Decrease porins
structure mutation
Decrease uptake
presumptive dx of TB in CSF
Lymphocytic pleocytosis (increase in lymphocytes)
hypoglycorrhacia (low glucose in CSF)
Toxicity of TB treatment
Occular and liver
Treatment for active TB
Months 1-2- Isoniazid (INH), rifampin (RIF), pyrazinamide (PZA) , and ethambutol (EMB)
Months 3-6 (up to 12 mos)- INH and RIF
How often should sputum samples be taken for active TB patients?
monthly
Latent TB therapy
9 months- INH
4 months- RIF
and monitor for active TB
When is someone contagious with influenza?
24 hours before, 3-5 days after but up to 7 days
Who should get antivirals for influenza?
Younger than 2, older than 65
immunosuppressed
Pregnant or 2 weeks post partum
Morbid obesity
CC resident
American Indian/ Alaskan native
Less than 19 on aspirin
Chronic conditions
Parts of virus identification
Virus Type/ Place/ Strain #/ Year/ Virus Subtype
A/ Sydney/ 05/ 97 (H3N2)
Pandemic influenza Phase:
Education- flu symptoms/ isolation
Vaccine
Facility plans for surge
Exp management plans
Just-in-time training plans
Comm plans
Phase 1-3
No human to human transmission
Phase?
Est # HCP needed
Start to increase isolation capacity
Review exposure management plan
Plan to sustain operation
Visitor screening plan
Staffing guidance for cases
Phase 4
Limited human- human transmission
Phase?
Enhanced screening and surveillance
Just-in time training
Schedule staff communications
Incident command
Phase 5
Sustained human to human transmission
Phase?
Implement surge strategy, staffing, supplies, and space
Cancel elective procedures
Implement employee exposure management plan
Phase 6
Efficient and widespread human - human transmission
Influenza iPC Plan
- early ID and isolation of patients
- annual education
- Vaccine to patients and HCP
- restrict ill patients and HCP
How long should flu pt be in isolation?
Private room, 7 days after onset and fever free for 24 hours
PEP for flu
High risk setting OB- antivirals for 2 weeks
Incubation for Hep A
28 days
(15-50 days)
How long does the prodromal phase of Hep A last in symptomatic patients? and the iciteric phase?
Prodromal (ILI, nausea, vomit)- 1-2 weeks
Iciteric Phase (jaundice, dark urine, pale stool, itch): up to 6 months
Window period for Hep A IgM test
5-10 days, within 3 weeks of exposure
Incubation for Hep B
90 days
(60-150 days)
Describe when each of the Hep tests will become positive:
HBsAg
HBeAg
anti-HBC
anti-HBS
HBV-DNA
HBsAg- 30 days
HBeAg- 30 days
anti-HBC- symptom onset
anti-HBS- after recovery
HBV-DNA- 30 days
Hep C incubation
2-12 weeks
(15-160 days)
Window period for anti-HCV and HCV RNA
Anti-HCV- 8-11 weeks
HCV RNA- 1-2 weeks after exposure
Testing for exposure to Hep C
Test ASAP and again 3-6 weeks after , RNA can detect earlier than anti-HCV
4th leading cause of community acquired pneumo
Legionella pneumophila
What increases the risk for aspiration of Legionella?
Intubation
Gen anesthesia
Nasogastric tube
Describe testing for legionella
Culture- 100% specific, 80% sensitive, use special selective media
Urinary antigen - sensitivity 80-90% and specificity 90-100%
DFA- Direct Fluorescent Antibody
Does not gram stain
Symptoms Legionnaire’s DIsease
Infiltrate in lungs
nonpurlent cough
pleural chest pain
Fever of 104
confusion*
hypoatremia (low sodium)
Incubation and recovery time pontiac fever
24-48 hours
2-5 days, self-limited
Treatment for legionella
quinolones and macrolides
Steps water safety plan
Describe H2O system
Assess risks
Control Risks
Audit
What are C. Diff toxins?
Toxin A
Toxin B
Binary toxin
Surge capacity: how many weeks should you have adequate resources available for?
6-8 weeks
Category: Brucellosis
B
Category: epsilon toxin Clostrium perfringens
B
Category: Food safety threats
B
Category: Glanders (burkholderia mallei
B
Category: Nipah virus
C
Category: Melloidosis (burkholderia pseudomallei)
B
Category: hantavirus
C
Category: Influenza
C
Category: Anthrax
A
Category: Smallpox
A
Category: Psittacosis (chlamydia pssitaci)
B
Category: Q Fever
B
Category: Ricin
B
Category: SARS
C
Category: Botulism
A
Category: Rabies
C
Category: Q fever (Coxiella Burnetti)
B
Category: Staphylococcol entertoxin B
B
Category: typhus fever (Rickettsia prowazecki)
B
Category: MDR-TB
C
Category: Plague
A
Category: Tularemia (Francisella tularensis)
A
Category: Yellow Fever
C
Category: Viral encephalitis
B
Category: Tickborne hemorrhagic
C
Category: Viral hemorrhagic fevers
A
Category: water safety threats
B
Precautions for fever >101.1F and cough in children
Droplet and contact
Precautions for vomitting
Standard
Precautions for watery or explosive stools, with or without blood
Contact
Precautions fever and rash
airborne
Precautions fever, upper chest rash, and stiff/ sore neck
Droplet
precautions eye infections
Standard
Precautions itchy rash without fever
Contact
Precautions petechial/ erythyromotic rash with fever
Droplet for 24 hours of antimicrobial therapy
Precautions: rash, positive history of travel to area with current outbreak of VHF in 10 days before onset
Droplet, contact, eye protection. Add N95 for aerosol generating procedures
Precautions macoulopapular rash with cough, coryza, fever
Airborne
Precautions vesicular rash in centrifugal pattern
Airborne and contact
What category of agents can be transmitted during autopsy? Which diseases is it unsafe to handle the dead bodies?
A
Choloera
VHF
smallpox
What are the two types of viral hemorrhagic fevers?
Filoviruses
Arenaviruses
Describe cutaneous anthrax
Incubation 1-12 days
Bulla develops and turns into necrosis
Standard and contact if copious drainage
Describe respiratory antrhax
Incubation 1-7 days
ILI progresses to dyspnea, shock, death in 85-90% untreated
Std precautions (not P2P)
If facility site of release or aerosolization: N95 or PAPR
PEP: vax + 60 days doxy or cipro
Describe botulism
Ingest/ inhale toxin
Incubation 1-5 days
Descending paralysis, resp failure
Standard precautions
Describe ebola
Transmission: mucous membranes, resp tract, broken skin/ percutaneous injury to body fluids of infected pt
Incubation: 5-10 days, up to 19
Symptoms: Vom, diarrhea, fever, hypotension, shock, hemorrhage
Precautions: Standard (esp HH, needle safety) + contact + droplet (or N95 for aerosol generating procedures)
Describe plague
inhalation
Incubation: 2-3 days
chills, ha, cough, dyspnea, rapid progression weakness and hemoptysis, circulatory collapse, bleeding diathesis
Precautions: standard and droplet for 48 hours after antibiotics
PEP for exposed HCP
Describe tularemia
Inhalation or ingestion
Incubation: 3-5 days
Symptoms: Pneumatic or typhoidal
Precautions: Standard
High risk: lab workers
Describe smallpox
Inhalation droplet/ contact with skin lesion
Incubation: 7-19 days
Symptoms: ILI vomit, centrifugal maculpapular rash around day 4 (more on face and extremities), and all lesions at same stage
Precautions: standard, contact, airborne for 3-4 weeks until all scabs separated
PEP: Vax within 4 days
IP for smallpox vax
cover vax site with guaze and semi-permeable dressing until scab separates (approx 21 days)
Adverse event:
- standard and contact until lesions crusted
Enteric:
onset 8-16 hours, lasts 24-48 hours, from meats, stews, gravies, vanilla sauce, vegetables, and milk products
Bacillus cereus
Enteric:
Onset 2-5 days, lasts 2-10 days
Symptoms: diarrhea, cramps, fever, vomiting, diarrhea, may be bloody
Source: Raw and undercooked poultry, unpasteurized milk, contaminated water
Campylobacter
Enteric:
Incubation: 8-16 hours, lasts 24-48 hours
Symptoms: Watery diarrhea, nausea, abdominal cramps, fever rare
Source: Meats, poultry, gravy, dried or precooked foods, time and/ or temp abused food
Clostridium perfrigens toxin
Enteric:
incubation 1-8 days, lasts 5-10 days
Symptoms: severe bloody diarrhea, abdominal pain, vomit, no fever
Source: undercooked beef (esp hamburger), unpasteurized milk and juice, raw fruits and vegetables, contaminated water
EHEC
Enteric:
Incubation 1-3 days, lasts 3-7 days
Symptoms: Watery diarrhea, abdominal cramps, some vomit
Source: Contaminated water or food
ETEC
Enteric:
Deadly for infants within a few days old
Cronobacter sakazakii
Enteric:
Incubation: 9-48 hours
Symptoms: Fever, muscle ache, nausea, diarrhea. Invasive disease within 2-6 weeks.
Source: fresh and soft cheese, unpasteurized milk, ready to eat deli meats, hot dogs
Listeria monocytogenes
Complications of Listeria monocytogenes
Pregnant women- premature delivery and stillbirth
Elderly/ immunocompromised- bacteremia or meningitis
Enteric:
Incubation 1-3 days, lasts 4-7 days
Symptoms: diarrhea, fever, abdominal cramps, vomiting
Sources: contaminated eggs, poultry, unpasteurized milk or juice, cheese, contaminated raw fruits and veggies
Salmonella spp
Enteric:
Incubation 24-48 hours, lasts 4-7 days
Symptoms: abdominal cramps, fever, diarrhea with blood and mucous
Source: ready to eat foods touched by infected workers, not common
Shigella
Enteric:
Incubation: 1-6 hours, lasts 24-48 hours
Symptoms: sudden onset of severe nausea and vomiting
Source: unrefrigerated meats, potato salad, and egg salads, cream pastries
S. aureus (entertoxin)
Enteric:
Incubation: 1-7 days, lasts 2-8 days
Symptoms: vomiting, diarrhea, abdominal pain, bacteremia, and wound infections
Source: undercooked or raw shellfish, especially oysters
Vibrio vulnificus
Complications of vibrio vulnificus
Immunocompromised or chronic liver disease: can be fatal
Enteric:
Incubation 24-48 hours, last 1-3 weeks
Symptoms: Appendicitis-like symptoms and vomiting, erythema nodosum
Source: undercooked pork, unpasteurized milk, tofu, contaminated water
Yersinia enterocolitica
Enteric:
Incubation period: 28 days, lasts 2-3 weeks
Symptoms: Diarrhea, dark urine, jaundice, ILI
Source: Shellfish, raw produce, contaminated drinking water, undercooked foods, foods handled by infected food handler
Hep A
Enteric:
Incubation: 12-48 hours, lasts 12-60 hours
Symptoms: Nausea, vomiting, ab cramping, diarrhea, fever, myalgia
Source: hands of HCP, P2P, aerosolized vomit, water
Norovirus
Enteric:
Incubation: 1-3 days, lasts 4-8 days
Symptoms: vomiting, watery diarrhea, low-grade fever
Risk: children, immunocompromised, elderly
Source: close contact within households, foods touched by infected workers
Very common childhood illness
Rotavirus
Prevention for rotavirus
Vaccine
Enteric:
Incubation: 3-4 days, sheds up to 35 days
Symptoms: watery diarrhea
Source: Shellfish, water, fomites
Astrovirus
Enteric:
Incubation: 8-10 days, last 2 weeks
Risk: Children under 4
Symptoms: Protracted diarrhea, or asymptomatic
Source: fecal/oral, droplet, transplants, p2P
Enteric adenovirus
Precautions for adenoviruses
Contact and droplet
Enteric:
Incubation 2-10 days
Symptoms- diarrhea, stomach cramps, slight fever, remits and relapses
Source: drinking water, undercooked food, food handled by sick food handler
Cryptosporidium
Enteric:
Incubation: 1-14 days
Symptoms: diarrhea, loss of appetite, substantial weight loss and fatigue
Source: fresh produce (berries), water, usually imported goods or related to travel
Cyclospora
Enteric:
Incubation period 1-2 weeks
Symptoms: malodorous diarrhea, malaise, flatulence, weight loss
Source: contaminated food or water, person to person
Giardia lamblia
Enteric:
Incubation 2-3 days to 1-4 weeks
Symptom: diarrhea for 1-6 weeks
Source: uncooked food or food contaminated by food handler, drinking water
Entamoeba histolytica
Enteric:
Incubation 5-23 days, or at birth in infants, lasts months
Symptoms: asymptomatic, lymphadenopathy, CNS in immunocompromised patients
Source: ingestion cat feces, raw/ partly cooked meat, perinatal
Toxoplasmosis
Enterobacteriaceae- lactose fermenters
E. coli
Citrobacter
Klebsiella
Enterobacter
Enterobacteriaceae- non-lactose fermenter
Salmonella
Shigella
Proteus
Pseudomonas
This virulence factor in gram-negative bacteria activates macrophages, white blood cells, releases cytotoxin, and causes septic shock, necrosis, DIC, and death
Lipid A endotoxin
This virulence factor provides resistance to antibodies, production of toxins, hemolysins, chromosomal or plasmid mediated
Pathogenic Islands
Virulence factor that helps Enterobacteriaceae evade immune mechanisms and phagocytosis
K antigens (capsule)
Virulence factor that helps Enterobacteriaceae with motility and adherence to GI and urinary epithelial cells
H antigens (Flagellar)
What antibiotics are carbapenemase producing klebsiella pneunominae resistant to?
Cephalosporins
monobactams
carbapenems
Enterobacteriaceae in the top 10 CLABSIs
Klebsiella
Enterobacter
E. Coli
Top Enterobacteriaceae for VAP
Klebsiella
Top Enterobacteriaceae for HAP
Enterobacter
Klebsiella
E. Coli
Top Enterobacteriaceae for HAI CAUTI
1) E. Coli
2) Klebsiella
3) Proteus
4) Enterobacter
5) Serratia
What HAIs does E. Coli typically cause?
CAUTI
CLABSI
VAP
SSI
What HAIs does Enterobacter cause?
Lower resp infections
UTI
wounds infections
Septecemias
Concern for Enterobacteriaceae
Multi-drug resistance, so treatment usually carbepenem
Motile fermenters Enterobacteriaceae
E. coli
Enterobacter
Serratia
Non-motile fermenter Enterobacteriaceae
Klebsiella
Motile non-lactose fermenters Enterobacteriaceae
Salmonella
Proteus
Non-motile, non lactose fermenting Enterobacteriaceae
Shigella
Yersinia
3 As of Klebsiella
Alcoholics, abscesses, aspiration
Carbepenemase producing genes
KPC
NDM
IMP
NDM
OXA-48
What antibiotic still typically works for CRE?
Fluoroquinolones
Most common flu strains in the last 30 years
H3N2
H1N1
TPN contamination
Fungi: C. albicans most freq, malassazia furfur
Gram + bacteria: Coagulase - staph
Gram - bacteria: E. coli, pseudomonas
Most common ESBL
Klebsiella and E. Coli
What antibiotics are ESBL resistant to?
third generation cephalosporins
monobactams
Common commensals that contaminate blood cultures
Corynebacterium
Bacillus
Propionibacterium
Coagulase-negative staph
Viridans group strep
Aerococcus spp.
Micrococcus spp.
Definition CLABSI (commensal)
2 positive cultures of common commensals from 2+ sets of blood cultures drawn <2 days apart AND patient has symptoms (fever, chills, hypotension)
Components of effective antimicrobial stewardship programs
1) leadership and culture
2) timely and appropriate antibiotic initiation
3) appropriate admin and deescalation
4) Data monitoring and reporting
Strategies for antimicrobial stewardship:
- Pharmacy restriction of meds
- audit and feedback
- antibiotic timeouts
- automatic stop orders
- documented indication
- dose optimization
- De-escalation (IV- oral)
Cultures that are NOT suitable for anaerobic culture and why
Why: contamination with resident anaerobic flora
Sputum
rectal swab
nasal/ throat
Urethral swab
Voided urine
Percentage of population exposed to coccidiodies in endemic regions
50%
Scabies incubation
4-6 weeks
RSV precautions
Contact + standard for duration of illness (mask when appropriate under standard precautions)
Most common cause of epidemic GI illness worldwide
Noro
Five major control factors for foodborne pathogens
1) person hygiene
2) adequate cooking
3) avoid cross-contamination
4) Keep food at safe temp
6) avoid foods from unsafe sources
Test for WNV
positive IgM- goes to public health lab
Precautions rabies
Contact precautions and eyewear and mask or face shield to protect mucous membranes
Shape of Borrelia burgdorferi
Spirochete
Primary causative agent transient aplastic crisis
Parvovirus B19
Treatment for parvovirus B19 in immunocompromised
immunoglobulin therapy
Precautions parvovirus B19
Droplet precautions
Resistance of Parvovirus B19
resistant to detergents, solvents, and heat. Stays in the environment for a long time
Symptoms parvovirus B19
Most asymptomatic
Slapped cheek rash (erythema infectiosum or fifth’s disease)
Prodrome: low-grade fever, cold symptoms
Few days later- rash
Infectious from symptom onset- 7 days after, most infectious in first 2 days
Incubation for parvovirus
4-14 days
Rash appears 2-3 weeks after infection
How parvovirus B19 transmitted
Droplet/ fomite, blood transfusion, vertical transmission
Complications parvovirus B19
spontaneous abortion in first 20 weeks of pregnancy
Transient aplastic crisis
Symptoms parvovirus in fetus
first trimester infection: anencephaly, spontaneous abortion
Second trimester: fetal hydrops and severe anemia
How long to isolate parvovirus B19 patient in transient aplastic crisis
7 days after admission, droplet or hospital stay if immunosuppressed
Surface proteins RSV
F (fusion)
G (attachment)
SH (small hydrophobic)
Infection control RSV
- HH
- cough etiquette
- cleaning/disinfection
- droplet and contact precautions
Most common cause of hospitalization for respiratory disease in chlidren
RSV
Incubation RSV, and when contagious
2-8 days
symptom onset until 3-8 days later
Treatment RSV
Palivizumab for high risk
Commensal fungi in GI tract and female genital tract
Candida albicans
Risk factors for fungal infections
Broad spectrum antibiotics
CVC
Immunosuppression
Neutropenia
Urinary catheter
Prothesis
TPN
When should you suspect candidemia?
High-risk patients with unexplained fever (esp if on broad spectrum antibiotics) or unexplained CNS signs and symptoms
Max hang time for lipid containing infusions
12 hours
Clinical presentation of aspergillus
cavitation/ fungal balls in the lungs/ fever/ hemoptysis
Most common viruses to cause meningitis
HSV, enteroviruses, arboviruses, mumps
Where does meningitis typically stem from?
organisms that colonize the nasophyrnyx
Precautions bacterial meningitis
H. influenzae and n. meningitidis- droplet 24 hours after appropriate microbial therapy
Precautions for aseptic meningitis
typically standard
Testing for CJD
- Western blot on brain tissue
- immunohistochemical tests for PrP on fixed tissue
- analysis of DNA extracted from blood or brain
- analysis of CSF for 14-3-3 protein
Highly infectious tissue CJD
Brain
Dura matter
Pituitary tissue
Spinal cord
Eye
*not CSF listed as low infectivity
Iatrogenic transmission of CJD
- pts exposed directly to infectious prion materials via inadequately sterilized neuro equip
- contaminated dura matter
- corneal transplants
- cortical electroencephalogram electrodes
- injections of cadaveric pituitary-derived growth hormone
4 chemicals that work on CJD
Chlorine
Phenol
Guanidine thiocyante
Sodium hydroxide
Parameters of pre-sterilization (before normal sterilization process from cleaning- sterilization) for CJD
prevac sterilizer- 134F- 18 min
Gravity displacement sterilizer- 132F- 1 hour
NaOh- 1 hour
How to clean contaminated surfaces with CJD
1:10 dilution sodium hypochlorite for 15 inutes
Reduction of red blood cell hemoglobin to methemoglobin leading to a green or brown zone of discoloration surrounding the colony on a blood agar plate
alpha-hemolysis
Complete lysis of red blood cells leading to a clear (transparent) zone surrounding the colony on a blood agar plate.
beta-hemolysis
Exotoxin produced by certain bacteria that have the ability to trigger excessive inflammatory immune response
Superantigen- examples: Strep pyogenes, S. dysgalactiae, S. equi
Group Strep A clinical
Pharyngitis
Scarlet fever
Erysipelas
Impetigo
Cellulitis
Necrotizing fascitis
Streptococcal toxic shock syndrome
Culture: white-to-gray colonies, 1 to 2 mm in diameter, and are surrounded by clear, colorless zones within which the red blood cells in the medium have been completely lysed
GAS, different from other beta-hemolytic strep because it’s susceptible to bacitracin
Gene to type for GAS
emm gene (codes for virulence factor)
If a patient has a sore throat, white spots, but a negative rapid antigen detection test for GAS, does that rule out strep?
No, test has 80-90% specificity so should culture
Precautions- Major GAS skin, wound, or burn infection that is draining
droplet, contact, and standard until 24 hours after initiation of effective therapy
Precautions GAS pharyngitis
Droplet until 24 hours after effective therapy
Precautions Scarlet fever
droplet for 24 hours after initiation of effective therapy
Precautions for strep pyogenes(GAS)
Droplet for 24 hours after initiation of effective therapy
Precautions group b strep neonatal disease
Standard
Precautions Strep pneumo, drug resistant
Standard, contact
Precautions non-drug resistant strep pneumo
standard
Risk factors for group b strep to infant born to colonized mother
- preterm delivery
- prolonged membrane repture during labor
- maternal fever during labor
- maternal history of prior infant with GBS sepsis
Most common cause of adult bacterial meningitis in the U.S.
Strep pneumo
Culture: gram +, α-hemolysis with partial lysis of red blood cells leaving a zone of greenish discoloration
Viridans group strep
Types of strep
GAS, GBS, viridans group strep, group C strep (animals), Group D strep (colon cancer, GI)
What are the common staph HAIs?
Bacteremia
Endocarditis
Pneumonia
Osteomylitis
SSI
Skin and soft tissue infections
Device associated infections
Risk factors for HA- MRSA
- LOS in hospital
- chronic wounds
- catheters
- antibiotics
MRSA resistance
Beta-lactams
macrolides
clindamycin
tetracycline
quinolones
aminoglycoside
Most common organism to infect CSF shunts
Staph epidermidis
How to dx scabies
prep skin with India ink to see burrows, microscopic examination of mites, or PCR
Treatment for scabies
Topical scabicide
Incubation scabies
4-6 weeks, as little as 10 days
Precautions scabies
Contact until 24 hours after treatment, may be longer for crusted scabies
PEP for scabies
Treatment for household members and intimate contacts
Outbreak response: scabies
Treat entire population at risk over the same 24-48 hour period, whether or not symptoms present and wash all clothing on hot cycle
Temp to kill scabies
Hot water wash at 122F for at least 10 minutes, and 10 minute dry
OR put linens in bag for 10 days
Survival of lice and lice eggs outside of host
2 days for head lice
30 days for eggs
Kill lice on personal items
140F for 5-10 min
Seal in bag 10-14 days
Freeze in bag for 12-24 hours
Human infestation of fly larvae
Myiasis
Kill bed bugs on personal items
Hot water wash at 120F for 10-20 minutes or freeze items
Heat items in room to 118 for 1 hour
Serogroups N. meningitidis
A, B, C, X, Y, W-135
Ages impacted by N. meningitidis
<5 years, 21 years, 65+
5 clinical manifestations of N. meningitidis
1) Bacteremia
2) Meningocomcemia without meningitis
3) Menigitis with or withouth meningococemia (70%)
4) Meningococcal encephalitis
5) Meningococcal pneumonia
What rash is commonly associated with N. meningitidis?
Petechial or purpuric rash
What condition related to a rash can lead to death from a N. meningitidis patient?
Purpura fulminans
What is a risk factor for meningococcal pneumonia?
Recent infection with virus
Antibiotics for N. meningitis
penicillin G and cephalosporins
When is vaccine for N. meningitiidis recommended?
Routine:
- all children 11 or 12
-Booster at 16-18
Campaign:
-3 cases from same serogroup in community <3 months
PEP for N. meningitidis
24 hours- 14 days after exposure
Rifampin
Ciprofloxacin
Ceftriaxone
Most common cause of encephalitis
Enterovirus (Coxsackievirus)
Period of communicability for N. meningitidis
7 days before onset to 24 hours after antimicrobial therapy
Incubation/ TBP/ HCP restriction/ PEP: conjunctivitis
Incubation: 24-72 hours
TBP:
viral- contact and standard
bacterial- standard
Restriction: Pt contact and pt env until discharge ceases
Incubation/ TBP/ HCP restriction/ PEP: acute diarrheal illness
Incubation: Varies
TBP: Contact for diapered and incontinent for duration of illness, may need negative stool samples
Restriction: pt contact, pt env, food until symptoms resolve
Incubation/ TBP/ HCP restriction/ PEP and post-exposure work-restrictions: Diphtheria
Incubation 2-5 days
TBP: Droplet until off antibiotics and 2 negative cultures 24 hours apart
Restriction: Exclude from duty until antimicrobial therapy complete and there are 2 negative samples
PEP: Exclusion and antibiotics
Incubation/ Symptom/ TBP/ HCP restriction/ PEP: Enterovirus (Coxsackie/ echovirus)
Incubation: 3-6 days
Symptom: resp, fever, rash, mouth sores
Contact: diapered or incontinent for duration of illness
Restriction: restrict from care of infants, neonates, and immunocompromised until symptoms resolved
Common name for coxsackie virus (which is an enterovirus)
Hand, foot, and mouth
Incubation/ TBP/ HCP restriction/ PEP Hep A
Incubation: Approx 28 days (15-50 days)
TBP: contact for diapered and incontinent until 1 week after jaundice, unless <3 years old and that is for duration of hospitalization
HCP: restrict from pt contact, pt env, and food handling until 1 week after jaundice
PEP: Hep A vax within 2 weeks
Incubation/ TBP/ HCP restriction/ PEP Hep B
Incubation: 90 days (60-150)
TBP: std, hemodialysis get their own space and equip
HCP: panel review exposure prone procedures
PEP: Source HBsAg positive and HCP susceptible- Hep B vax and HBIG
Incubation/ TBP/ HCP restriction/ PEP Herpes
Incubation: 2-12 days
Contact for severe/ disseminated disease until lesions dry and crust
Restrictions:
Herpetic whitlow: HCP from pt contact/ pt env until lesions dry and crust
Orofacial- cover and restrict from patient care immunocompromised
Incubation/ TBP/ HCP restriction/ PEP HIV
Incubation: 1-6 weeks
Standard precautions
restrictions: panel review for invasive exposure prone procedures/ local/ state health regs
PEP: within 72 hours, PEP will depend on pt viral load
Incubation/ TBP/ HCP restriction/ PEP and post-exposure work-restrictions: Measles
Incubation: 10-12 days to symptoms, 14 days to rash
TBP: airborne and standard until 4 days after rash onset
Restriction: Exclude for 7 days after rash onset
PEP: exclude day 5-21 if exposed and no symptoms, 4 days after rash if one develops
Vax within 72 hours of exposure or Immunoglobulin within 6 days
Incubation/ TBP/ HCP restriction/ PEP and post-exposure work-restrictions: meningococcal disease
Incubation: 2-10 days
TBP: droplet for 24 hours after initiation of effective therapy
Restriction: exclude from duty until 24 hours after effective therapy
PEP: prophy antibiotics within 24 hours for HCP without mask and close contact (intubation, mouth to mouth, suctioning), household, partners
Incubation/ TBP/ HCP restriction/ PEP and post-exposure work-restrictions: mumps
Incubation: 16-18 days (12-25 days)
TBP: Droplet until 5 days after parotitis onset (updated from 9)
Restrict: exclude from duty until 5 days after parotitis (updated from 9)
Post exposure: Exclude susceptible days 12-26 or 5 days after parotitis
Incubation/ TBP/ HCP restriction/ PEP and post-exposure work-restrictions: Pediculosis
Incubation: 7-10 days
TBP: contact until 24 hours after initiation of therapy
Restrict: no patient contact until treated and observed lice free (24 hours after initiation of therapy)
Incubation/ TBP/ HCP restriction/ PEP and post-exposure work-restrictions: Pertussis
Incubation: 7-10 days (6-21 days)
TBP: Droplet until 5 days start of antibiotics
Restriction: Exclude until 5 days after the start of effective therapy
PEP: Z-pack
Incubation/ TBP/ HCP restriction/ PEP and post-exposure work-restrictions: Rubella
Incubation: 14 days (12-23 days)
TBP:
congenital: contact until 1 year old
Adult: droplet for 7 days after rash onset
Restriction: Exclude until 5 days after rash onset
Post-exposure: Exclude susceptible day 7- day 21
PEP: Vax within 72 hours in non-pregnant, susceptible contacts
Incubation/ TBP/ HCP restriction/ PEP and post-exposure work-restrictions: Staph aureus
Incubation: Varies
TBP: furunculosis/ draining lesions: contact until wounds stop draining
Restriction: Draining lesions: restrict from pt contact, pt env, and food until lesions no longer draining
Incubation/ TBP/ HCP restriction/ PEP and post-exposure work-restrictions: GAS
Incubation: varies
TBP: Droplet, contact if lesions present for 24 hours after start of appropriate therapy
Restrictions: pt care, pt env, and food until 24 hours after effective antimicrobial therapy
Incubation/ TBP/ HCP restriction/ PEP and post-exposure work-restrictions: Active TB
TBP: airborne, draining lesions- contact and airborne until effective therapy, improving, and 3 consecutive negative sputum smears 8-24 hours apart
Restriction: exclude HCP until deemed non-infectious
Post exposure: test immediately and 12 weeks after exposure
Incubation/ TBP/ HCP restriction/ PEP and post-exposure work-restrictions: Varicella zoster
Incubation: 14-16 days (10-21 days)
TBP: Airborne and contact (but no mask for vax, no recommendations for surgeon or N95 for susceptible) until all lesions crust and dry
Restriction: Exclude until all lesions crust and dry
Post exposure: Exclude susceptible day 10-day 21 (28 for VZIG)
PEP: Vax within 5 days, VZIG for preg and immunocompromised
Incubation/ TBP/ HCP restriction/ PEP and post-exposure work-restrictions: Herpes zoster
TBP:
Localized immunocompetent- standard
Disseminated immunocompetent: airborne and contact
Disseminated or localized immunocompromised: airborne and contact
For duration of illness
Restriction:
Localized: cover lesions, restrict from high risk patients until all lesions crust and dry
Generalized or immunocompromised: restrict from pt contact until lesions crust and dry
Post exposure: susceptible exposed to disseminated or immunosuppressed pt: exclude from day 10 - day 21 (28 VZIG)
Incubation/ TBP/ HCP restriction/ PEP and post-exposure work-restrictions: Ebola
Incubation: 8-10 days (2-21)
TBP: Droplet, standard, and contact for duration of illness
Exclusion: Exclude for duration of illness
Post exposure: State regs differ- exclusion may be for 21 days post exposure
Incubation/ TBP/ HCP restriction/ PEP and post-exposure work-restrictions: Scabies
Incubation: 4-6 weeks
TBP: contact until 24 hours after start of effective therapy
Restriction: restrict from pt contact/ pt env for 24 hours after effective therapy
Contagious period for measles
1-2 days before until 4 days after rash
3 cs of measles prodromal phase
Cough, coryza, conjunctivitis
Word to describe measles rash
Morbiliform
Complications of measles
- otitis media
- bronchopneumonia
- bronchitis
- splenomegaly
- encephalitis
- death
Condition that may occur years after measles infection in the very young
Subacute sclerosing panencephalitis (SSPE)
transport of measles test specimen
ASAP- measles liable
4 degrees C (freezing causes loss of virus)
sample early in acute phase
What vitamin deficiency is related to measles?
Vitamin A
Vaccine info for MMR
Live attenuated
Give at 12 months and before school (4-6 years)
Who should not receive the MMR vaccine?
Pregnant
Severely immunocompromised
Recent recipients of immunoglobulin or blood products
If another patient was exposed to a measles case and is susceptible, what is recommended for the exposed pt?
- AIIR for 5-21 days after exposure
- Vax within 72 hours
Contagious period mumps
1-2 days before until 5 (formerly 9) days after parotitis
% of mumps patients that are asymptomatic
30-40%
When is the highest risk for congenital rubella?
early pregnancy in first 12 weeks
Symptoms congenital rubella
- retarded growth
- mental retardation
- congenital heart disease
- deafness
- ocular abnormalities
- anemia
- hepatosplenomegaly
- increased miscarriages
- increase stillbirths
Rubella symptoms adult
25-50% asymptomatic
otherwise prodrome with ILI and then maculopapular rash, arthritis, and arthralgia (in women) for 3-5 days
Contagious window for rubella
7 days before rash until 7-14 days after rash
Testing: rubella
Send to CDC for confirmation
Usually use serology (IgM or paired IgG) since viral iso difficult
Typical age range for mumps cases
5-19 years old
Primary virulence factor for pertussis
Pertussis toxin
How does pertussis toxin work?
PT prevents migration of lymphocytes to areas of infection and adversely affects phagocytosis and glucose metabolism, causing compensated insulinemia
Complications of pertussis:
pneumonia
seizures
encephalopathy
death
Describe the vaccine for pertussis
Acellular vaccine
4 doses DTAP (2,4,6, and 15-18 months)
Booster 4-6 years
TDAP- 11-18 years (best around 11-12)
Every pregnancy
19+- Tdap for adults that never received a dose
Recommendations if multiple patients exposed to pertussis?
PEP and cohort
additional measures for more extensive respiratory outbreaks/ community spread
Universal masking
limit visitation
exclude sick children from daycare
Herpes viruses
HH1 (HSV-1)
HH2 (HSV-2)
HH3 (VZV)
HH4 (EBV)
HH5 (CMV)
HH6 (HHV-6)
HH7 (HHV-7)
HH8 (KSHV)
HHV that causes:
B cell lymphoma
Hodgkin lymphoma
NP carcinoma
Hairy leukopenia
EBV
Common name for HHV-6 and HHBV-7
Roseola
HHV that can cause:
Primary effusion lymphoma
Multicentric Castleman disease
HHV-8 Kaposi Sarcoma
HHV that causes gingivostomatitis
HSV-1
What differentiates chickenpox and measles:
Measles: conjunctivitis, rash appears on forehead, hacking cough, koplik spots
Chickenpox: rash appears on chest, face and back, decreased appetite, spots turn into itchy blisters
Symptoms congenital CMV
- petechiae (blueberry muffin rash)
- jaundice
- hepatosplenomegaly
- microcephaly
- hearing loss
- eye abnormalities
- developmental delays
Type of virus herpes
DNA
Life threatening herpes virus for patients with severe skin conditions like burns
Eczema herpeticum
Biggest complications risk for Varicella
Secondary bacterial infection
Healthcare populations of concern for herpes viruses
Immunocompromised
Solid Organ transplants
Hematopoietic stem cell transplants
Most common disease to cause birth defects in the United States
CMV
Illness that causes gray baby syndrome (Pallor, hypotension, and resp destress) in preterm babies infected after transfusion
CMV
Clinical outcomes of AIDS and transplant recipients that get CMV
Interstitial pneumonia
Cytomegalo-retinitis
Cytomegalo-enteritis (GI issues)
What is the mortality rate of post-transplant lymhoproliferative disease from EBV?
50%
95% of children are infected with this disease by age 3
HH6 (roseola)
Concerns for HHV6 in transplant recepients
- HSCT can reactivate
Allogenic transplants- can cause graft rejection
Screening recommendations for HIV
once age 13-64
more frequently (every 6 months- 1 year for higher risk behavior)
Most common opportunisitic infections HIV
Pneumocysitis jiroveci
TB
Disseminated mycobacterium avium
Disseminated mycobacterium kansasaii
CDC core strategies for HIV
1) Dx
2) Prevent
3) Treat
4) Respond
Tests for HIV and description:
1) rapid antibody tests (23-90 days after infection), require confirmation for positive with HIV antibody differentiation immunoassay
2) Viral p24 antigen/ antibody test (venous 18-45 days after exposure, fingerprick (18-90 days after exposure)
3) NAAT (10-33 days after exposure)
Work restrictions for hcp with RSV
HCP with acute resp symptoms should NOT provide care to high-risk patients
When to provide education about MDROs
At hire and routinely as changes occur
Elements of an occupational health program
1) Educate HCP about IP and their responsibility for IP
2) Investigate exposures to OBs
3) Provide care to HCP with work-related illness/ exposure
4) ID infection risk to preventative measures
5) contain costs by preventing infectious diseases that result in absenteeism/ disability
Elements of a the respiratory protection program:
- Person specially trained to oversee program
- administrator evaluate effectiveness of program
- training & demonstration of use by employee
- Sufficient number, models, and sizes
- Fit test annually or as needed
- Seal check with each use
Elements of exposure control plan and how often to review
Annually
1) protective measures provided by employer
2) engineering/ work practice controls
3) PPE
4) HBV vax within 10 days of hire
5) Training
Ways to measure needlestick injuries
Occupied Beds: Needlesticks / Bed/ Year:
# needlesticks/ total occupied beds
Occupation: Needlesticks/ nurses/ year
# needlesticks reported by nurses/ # full time nurses employed
Device-based rate: needlesticks/ device type/ year
# needlesticks from device type/ # device type used or purchased
General HIV PEP
Most exposures warrant 2 drug regimen with:
2 nuceloside reverse transcriptase inhibitors (NRTIs) or
1 NRTI and 1 nucleotide reverse transcriptase inhibitor
What are the components of a successful occupational health
1) leadership and management
2) Communication, collaboration, assessment, and reduction of risk for HCP
3) Medical evaluations
4) Occupational education and training for infection prevention including essential precautions for disease transmission
5) Management of testing protocols and return to work guidelines
6) HCP treatment
7) Immunizations
8) Testing protocols
9) management of potentially infectious exposures and responses
What’s the recommendation for MMR if born before 1957?
If no immunity per lab evidence for rubella, get 1 dose of MMR
If exposure to varicella occurs after vaccination series is started, does HCP need to be exluded?
No, but they should be monitored for symptoms daily days 10-21 (or 28 if they get VZIG)
When should meningitis PEP be started?
within 24 hours of exposure, no more than 2 weeks
What antibiotics for meningitis PEP are contraindicated for pregnant women?
Rifampin
Cipro
They can take ceftriaxone
unique symptom of Hep B
Scleral icturus
When to test for HCV after exposure
Baseline testing for anti-HCV and ALT, RNA testing at 4-6 weeks after exposure, then repeat anti-HCV and ALT at 4-6 months after exposure
When to test for HIV after exposure
Baseline, follow up testing for 6 months
Timeline to start HIV PEP
72 hours
Higher risk HIV exposures
Patient symptomatic, has AIDS or high viral load
Exposure from large hollow needle, deep puncture, needle used in patient artery or vein
When would you use an expanded 3-drug PEP for HIV?
PT HIV class 2 for less severe or more severe exposure
OR
PT HIV class 1, but there is a more severe exposure
What PEP is most often recommended for mucous membrane exposures to HIV?
2-drug unless patient HIV class II and large volume of blood into mucous membrane
How to make IVs and central lines safer for HCP
Replace IV, aerterial, and central line tubes with needless or blunt canula devices
What can be done to make scalpels safer
round tipped scalpel blades
alternative material blades (silicone)
retractable, disposable blades
Hierarchy of controls
Most effective to lease effective:
Elimination
substitution
engineering
administrative controls
PPE
What vaccine contain egg?
MMR and influenza
What vaccines contain thimerosal?
DTAP, DT, Td
Influenza
Meningococcal
Who should avoid live vaccine?
- Pregnant or planning to become pregnant in 28 days
- Symptomatic HIV
- Treatment induced immunosuppression
- Malignancy
- Receipt of antibody production within window of vax
Immunoglobulin available for these diseases
Hepatitis A
Hepatitis B
Chickenpox
Tetanus
Measles
Rubella
Rabies
Who is considered at risk and should get the Hep B vaccine?
- STI treatment facilities
- HIV testing and treatment facilities
- drug abuse treatment/ prevention
- healthcare targeting MSM/ drug/users
- correctional facilities
- hemodialysis
- developmental disabilities
- HCP with risk to blood exposure
What age group should not get LAIV?
> 49 years (higher risk for severe complications from flu)
How many doses of MMR and how far apart?
2 doses, 28 days apart, after 1st bday
Can you give MMR vaccine and the TST test at the same time?
Yes, same day as vaccine or wait 4 weeks for TST
Can you give live vaccines at the same time?
Yes, but you should give them the same day OR wait until 28 days between live vaccine if not the same day
Can patients with HIV get the MMR vaccine?
Yes if asymptomatic and CD4 >15%
What is a potential side effect of rubella vaccine in adults
increased risk of arthritis and arthralgias
If getting an elective splenectomy, when should you get the pneumococcal vaccine?
2 weeks before
GBS linked to what vaccines?
Flu (1970s)
Tdap?
COVID
Is there an indication for Tdap as part of an outbreak response?
No
What type of vaccine is vaccinia?
Live vaccine- smallpox
Who should be vaccinated for smallpox in a routine non-emergency? How often?
- Lab workers who work with vaccinia or orthopox viruses that infect humans (every 3 years)
Those who administer smallpox vaccine to others (every 10 years)
How long should you wait to do a TST after smallpox vaccine
1 month
What is a concern for vaccinia vacine?
Live vaccine can cause the virus to be transmitted to close contacts
What vaccine are the follow considerations for close contacts for:
- cardiac disease
- eye disease with topical steroids
- immunodeficiency disorders
- eczema
- pregnancy
- breastfeeding mothers
- infants
- 3 or more cardiac risk factors (hypertension, diabetes, high cholesterol)
- latex sensitivity
Vaccinia vaccine
What are the side effects of the vaccinia vaccine? Note, most people will have at least 1 adverse event
Rash
Inadvertent ocular inoculation
myocarditis
This live vaccine can cause a rash in immunocompromised and potentially transmit disease to others
Varicella
Proof of immunity: varicella
1) written 2-dose vax record
2) lab evidence
3) physician verified dx
Indications for meningococcal vaccine
- asplenia
- travel to countries with endemic meningococcal disease
- lab employees with exposure
Goals of the HCP vax program
1) achieve high rates of immunization
2) Devise and implement specific vaccine strategies
3) provide education about vaccine
4) Justify the cost
Can Hep B vaccine be frozen?
No
Do HCP born before 1957 have to provide lab evidence of disease?
Yes- all HCP must have documented immunity against measles
Is there a booster for polio?
Yes, booster recommended for high-risk
What vaccines should be frozen?
Vaccinia
Powdered varicella vaccine
Recommended vaccines for healthcare workers
Hep B
Influenza
MMR
Tdap
Type of temperature monitoring device recommended by CDC
Digital Data Logger
Way to measure temperature in vaccine fridge
Buffered temp probe with buffer (glycol, glass beads, sand, teflon)
difference between expiration date and beyond use dates on vaccines
Expiration - final day that vaccine can be used
Beyond use- last date or time that vaccine can be safely used after it was moved
When to discard multi-dose vials
after max number of doses drawn, exp date, or 28 days after first puncture, whichever comes first
What is the maximum number of transport + clinic hours for a vaccine?
8 hours
Vaccine storage requirements
- original packaging, , labeled separate containers
- middle shelf away from walls/ ceiling/ floor/ door
- temp stable area
- store with diluent
- leave room for circulation
What should be used to keep vaccines cold during transport?
Phase change materials
What diseases are standard precautions the only preventative measure?
CMV (Std)
HCV (std)
Parvovirus B19 (droplet)
TB (airborne)
What vaccines are contraindicated for pregnant women?
HPV
Live flu (LAIV)
MMR
Varicella
Zoster
What vaccines are recommended during pregnancy?
inactivated flu
Hep A if indicated
Hep B sometimes
Tdap
What is the concern if a pregnant woman cares for an immunocompromised patient with chronic anemia?
Parvovirus B19
What diseases can pregnant women take PEP chemoprophylaxis for?
N. meningitidis
Syphillis
HIV
What birth defects can varicella cause?
- malformations (skin, limb, CNS, eye)
Requirements for volunteers, contract workers, etc..
1) review medical eval and immunizations programs for facility
2) Process for management of job-related illnesses and exposures, including work restrictions
3) Counseling services related to exposure
4) maintenance and confidentiality of health records
What education should be offered to nonemployee HCP
- IP policies and procedures and their locations
- chain of infection/ modes of transmission
- BBP exposure prevention and plan
- TB education and plan
- HH
- PPE
- Fed, state, and local regulations
- process to report events, near misses, and unsafe work practices
Actions taken to decrease the potential impact of a sitution
mitigation
measures taken before an event that help prepare an individual, facility, or community to respond to the emergency
preparedness
Intervention undertaken in response to a known or suspected event
Response
Intervention implemented after the emergency has been declared over
Recovery
Water needed for emergency management
25 gal a day for pt care
Control to reduce the likelihood of an exposure by altering the manner in which the task is accomplished
administrative and work practice controls
Example- training HCP on safer technique to recap needle
Clinical symptom primary TB
Erythema nodosum
Fever
Cough
Gohn complex
Parts of the TB control plan
1) risk assessment
2) Administrative controls (methods to ID pts and get to AII)
3) Environmental Controls
4) Respiratory protection
Leading cause of NTM in the U.S.
Mycobacterium avium complex
Bacteria that cause pneumonia most often in older adults (65+)
Strep pneumo
Klebsiella pneumo
Pseudomanas
Legionella
How long should chemoprophylaxis continue during a flu outbreak?
at least 14 days, 7 days after the last case
What vaccines are recommended for older adults (as routine vax)
Flu (high antigen)
COVID
TDAP (if never had one before) and TD every 10 years
Pneumo
Zoster
Most common HAI in neonates
BSIs
Pneumonia
Standard Precaution Components
- Hand hygiene
- Appropriate use of PPE
- Respiratory hygiene/ cough etiquette
- Proper placement of patients
- Safe injection practices
- Disinfection and sterilization of reusable medical equipment
5 moments of hand hygiene
1) before touching a patient
2) before a clean or aseptic procedure
3) after body fluid exposure risk
4) after touching a patient
5) after touching patient surroundings
Are ambulatory centers required to use precautions for MDROs?
No, Due to the shorter stays and typically lower intensity of care, the risk of spread of MDROs in outpatient facilities is generally reduced and as a result, many ambulatory facilities may choose to not use precautions
How much space should there be around furniture/ procedure tables in ambulatory centers?
3 feet
Recognize antigens, differentiate into plasma cells that secrete antibodies (immunoglobulins), which inactivate microorganisms alone or in combination with complement phagocytes
B-lymphocyte
Help or suppress cell function, may also be cytotoxic, killing target cells that express foreign antigens
T-lymphocytes
Immune cells that help fight bacteria and fungi, migrate toward site of infection (chemotaxis), ingest and kill microbes
phagocytes (including neutrophils, eosinophils, basophils, monocytes, and macrophages)
What is are the precautions for a TB autopsy?
N95
What patients are at increased risk for fungal infections?
- Leukemia
- Solid tumors and leukopenia
- Bone marrow transplant
- Injection drug users
- Pts with intra-abdominal or cardiothoracic surgery
- Burn victims
- Premature/ low birth weight infants
Do antimicrobials in multidose vials protect against:
Bacteria
Viruses
Bacteria- yes
Viruses- no
What do you look for during an antibiotic time out? When should the timeout occur?
- Correct dose
- Duration of therapy
- Indication for treatment
24-48 hours after culture results
How far must sterile items be stored from the ceiling or sprinklers?
18 inches
How far must sterile items be stored from the floor?
8-10 inches
What type of pressure is needed in a sterile storage room
positive
How many ACH for sterile storage rooms?
at least 4, but 10 preferred
Temperature of sterile storage room
65-72F
What infections require mothers to withhold breastmilk?
HIV
HSV on breast
WNV
Human T-cell lymphotropic virus type I or II
Active TB (but can pump and give milk to baby if treatment not contraindicated)
Humidity sterile storage
35-75%
ACH/ pressure for decontamination/ contaminated storage area
Negative, 10 ACH
Portals of entry for CVCs
- Stopcocks for medicine injection (cap when not in use, closed systems preferred)
- Admin IV infusions
- Collection of blood samples
Which type of alcohol has greater activity against:
Bacteria
Viruses
Bacteria: isopropyl alcohol
Viruses: ethyl alcohol
Types of antiseptics
- Alcohol
- Chlorohexidine
- Chlorine
- Hexachlorophene
- Iodine
- Chloroxylenol (PCMX)
- Quat ammonium
Indications for hand washing
- visibly soiled
- Before eating
- Before preparing food
- after using the bathroom
- exposed to spire-forming organisms
Per fire code, what is the minimum width of the corridor with hand sanitizer dispensers, and how far apart must they be?
- 6 feet
- 4 feet apart
What antiseptic agents have persistent activity against bacteria?
CHG
Iodophers
Process for surgical hand antisepsis
remove jewelry, clean nails, wash hands and arms
How to improve HH?
- administrative support
- convenient and acceptable products/ dispensers
- monitoring and feedback
- role modeling- excellent HH
- Motivational/ incentive programs
What is required for HH by the TJC?
Education, monitoring, and feedback
Type of hand hygiene monitoring with the following pros:
Real-time corrections
- assess HH technique and durations
- ID reasons for missed HH opportunities
- Pts and families can observe and notify
Direct Observation
Type of hand hygiene monitoring with the following pros:
- Always in place
- Capture all HCP and visitors
- Minimized hawthorne effect
- Not time consuming
- Just-in-time reminders
- Consistent
Automated monitoring (sensing devices)
Type of hand hygiene monitoring with the following pros:
- Less time and resources
- All the time
- Better for difficult to observe areas, like the OR
Product volume monitoring
Type of hand hygiene monitoring with the following cons:
- Time consuming
- Difficult to recruit observers
- Variability of observers
- Hawthorne effect
- Biased to weekday/ day shifts, captures small portion of HCP
Direct observation
Type of hand hygiene monitoring with the following cons:
- $$
- HCP need special badge
- Rely on entry/ exit but may not detect other HH moments
- No immediate feedback
- Unpopular with HCP
Automated Monitoring
Type of hand hygiene monitoring with the following cons:
- Need accurate supply info at the unit level
- documenting data can delay distribution
- cannot assess technique or duration
- cannot discern HCP/ visitor use
Product volume monitoring
Calculations for HH through product volume monitoring
Volume used (specific product) / 1000 pt days
Reasons for poor HH adherence
- Lack of knowledge
- Increased demands with less time
- Irritated, dry hands
- Lack of soap and paper towels
- Inaccessible sinks
- Shortage of sinks
- Belief that wearing gloves replace need tor HH
- Lack of administrative sanctions
This ruling protects employees from unprotected contact with patient blood, body fluid, secretions, excretions, mucous membranes, and non-intact skin
OSHA Bloodborne Pathogen Standard (1991)
What is needed for success of a BBP program
- administrative support
- Education
- Policies and procedures
- Institutional culture
When to use gloves under standard precautions
Touching:
- mucous membranes
- non-intact skin
- blood
- body fluids
- secretions
- excretions
- contaminated objects
Examples of safe work practices
- check PPE before contact (so not re-adjusting)
- Position pt so sprays/ splatters –> away from HCP
- Barrier for resuscitation
What patients should be prioritized if single room is not available?
Pts with poor hygiene/ etiquette or increased risk for severe outcomes
Standard precautions
- Hand hygiene
- PPE
- Resp/ cough etiquette
- Safe work practices
- Env cleaning
- Safe injection practices
- Patient placement
What HCP should be restricted from working with patients on airborne precautions?
- immunocompromised
- pregnant
- Susceptible
What policies and procedures are needed regarding transmission based precautions?
- Chemoprophylaxis
- PEP
- Immunization
- TB screening for HCP
When to use contact precautions
Heavy environmental contamination
Diseases transmitted by contact with pt or pt env
PPE for contact precautions
Gown and gloves
What PPE should env where for cleaning contact precautions rooms.
Gown and gloves
What should be used for terminal cleaning of contact precaution rooms
HP or UV light
Distance between patients for droplet precautions
6 ft
Type of masks required for:
TB
Smallpox
Measles
Chickenpox
TB- N95
Smallpox - N95
Measles- N95 or surgical mask (if not immune)
Chickenpox- N95 or surgical mask (if not immune)
How many ACH for protective env
12 ACH
Administrative measures for MDRO control
- implement active surveillance culturing (based on risk assessment)
- activate computer alerts for colonized patients
- provide accessible and frequent sinks/ abhr dispensers
- maintain nurse staffing levels
- enforce HH adherence
- enforce contact precaution adherence (including cohorting pts)
Surveillance for MDROs
- monitor microbiology isolates
- calculate incidence/ infection rates
Use molecular typing for investigating outbreaks - active culture surveillance
Planning for active surveillance cultures
- provide additional personnel to obtain cultures and additional lab personnel to process cultures
- ensure turnaround time for screening results
- monitor adherence to contact precautions
- provide mechanism for communicating results to HCP
- measure outcomes to evaluate the effectiveness of active surveillance cultures and contact precautions
Control methods for MDROs
- Administrative measures/ adherence monitoring
- MDRO education
- Judicious use of antimicrobials
- Surveillance
- Isolation precautions
- Environmental measures
- Decolonization
How long MDRO patients are on contact precautions
Duration of hospital stay
Antimicrobial agents that may be targeted for MDRO control
- vancomycin
- third generation cephalosporins (including for ESBLs)
- anti-anaerobic agents VRE
- quinolones
- carbepenems
If single rooms/ cohorting patients with the same MDRO is ot possible, who should room with a patient with an MDRO
pts at low risk of getting the MDRO (lower acuity), have short lengths of stay, and are not associate with adverse outcomes
How long after surgery should you use sterile gloves?
24 hours
How long after surgery should you use sterile dressings?
24-48 hours
When to use clean technique
- wound care
- peripheral venous catheters
- respiratory suctioning
Pressure for OR
positive
Type of gloves and type of technique for wound cleaning
Clean gloves, clean technique
Type of gloves and type of technique for routine dressing changes without debidement
Clean gloves, clean technique
Type of gloves and type of technique for dressing change with mechanical, chemical, or enzymatic debridement
clean gloves, clean technique
Type of gloves and type of technique for dressing change with sharp, conservative bedside debridement
sterile gloves, sterile technique
Type of gloves and type of technique for central line dressing change
Sterile gloves, sterile technique
Type of gloves and type of technique for tracheal suctioning when the tracheal suction is not within a closed sheath
Sterile gloves, clean technique
Type of gloves and type of technique for tracheostomy care or suctioning within a closed sheath
Clean gloves, clean technique
What are the aspects of aseptic technique
- barriers
- patient and equipment preparation
- environmental controls
- contact guidelines
process for keeping away disease producing microorganisms
asepsis
Technique to prevent the transfer of any organisms from one person to another or from one body site to another
Surgical asepsis/ sterile technique
Technique to practice interventions that reduce the numbers of microorganisms to prevent and reduce transmission risk from one person (or place) to another
Medical asepsis/ clean technique
Timeline to follow superficial SSI
30 days
Timeline to follow secondary incisional SSI
30 days
Surgeries that require 90 day follow up for deep incisional or organ space SSI
- Breast surgery
- Cardiac surgery
- Coronary artery bypass graft
- Craniotomy
- Spinal fusion
- Open reduction of fracture
- Herniorrhaphy
- Hip prosthesis
- Knee prosthesis
- Pacemaker surgery
- Peripheral vascular bypass surgery
- Ventricular shunt
Signs/ symptoms deep tissue/ organ space infections
- abscess
- deep incisional (primary/ secondary)
- osteomyletis
- -itis of the surrounding organ or space (ie endocarditis)
- arterial/ venous infection
- intrabdominal, not specified elsewhere
- other infections of lower respiratory system
NHSN Superficial SSI definition
- DOE within 30 days of operative procedure
- AND involves only skin and subcutaneous tissue of the incision
- AND pt has at least one of the following:
1) purulent drainage from the incision
2) organism ID’d from superficial site by culture or non-culture
3) Dx of SSI
4) Superficial incision deliberately opened by HCP and further testing not performed AND patient has one of the following:
a) localized pain
b) tenderness
c) localized swelling
d) erythema/ or heat
NHSN deep incisional SSI definition
- DOE within 30 or 90 days of procedure
- AND involves deep soft tissues of incision (facial/ muscle layers)
- AND patient has least one of the following
1) purulent drainage from deep incision
2) Abscess or other evidence of infection involving deep incision detected in fross anatomical or histopathological exam or imaging test
3) Deep incision spontaneously dehices (bursts open) or is deliberately opened or aspirated
a) AND organism from deep soft tissue ID’d from culture/ non-culture
b) AND patient as either fever or localized pain and tenderness
NHSN organ/ space SSI definition
- DOE- withing 30 or 90 days of the procedure
- AND involves any part of the body deeper than the facial/ muscle layers
- AND patient has at least on of the following:
1) Purulent drainage from drain placed into organ/ space
2) Organisms ID’d from fluid or tissue in organ/ space by culture or non-culture test
3) An abscess or other evidence of infection involving the organ/ space detected on gross anatomical or histopathological exam, or imaging test evidence suggestive of infection - AND infection in an organ/ space (ie osteomyletis, Pharyngitis, meningitis, joint or bursa infection, disc space infection, etc.)
What information is collected for each operative procedure?
- wound class
- ASA score
- Trauma
- Closure technique
- Duration of procedure
- General anesthesia?
- emergency procedure?
- Diabetes mellitus
Uninfected, operative wound in which no inflammation is encountered and the respiratory, ailmentary, genital, or uninfected urinary tract is not entered. Primarily closed, and if necessary, drained with closed drainage.
Clean wounds
Wounds class of operative incisional wounds that follow nonpenetrating (blunt) trauma
Clean wound
Operative wound in which the respiratory, ailmentary, genital, or urinary tracts are entered under controlled conditions and without unusual contamination.
Clean contaminated wound
Wound class for operations of biliary tract (ie chloecystectomy)
Clean contaminated wound
Wound class for operations of the appendix (appendectomy)
Clean contaminated wound
Wound class for operations of the vagina (hysterectomy)
Clean contaminated
Wound class for operations of the oropharynx (tonsilectomy)
Clean contaminated
Open, fresh, accidental wounds. Operations with major breaks in sterile technique or gross spillage from the GI tract, and incisions in which acute, nonpurulent inflammation is encountered.
Contaminated
Wound class of open cardiac massage
Contaminated
Wound class perforated bowel
Contaminated
Old traumatic wounds with retained devitalized tissue and those that involve existing clinical infection or perforated viscera.
Dirty/ infected
Wound class: wound with purulence/ existing clinical infection
Dirty/ infected
Wound class: wound with perforated viscera
Dirty/ infected
Wound class: open traumatic wounds >4 hours
Dirty/ infected
Wound class: wound with devitalized tissue
Dirty/ infected
Wound class: wound with penetrating injuries > 4 hours
Dirty/ infected
Wound class: Wound with acute, nonpurulent inflammation
Contaminated
Wound class: wound with gross (any) spillage from the GI tract (bile)
Contaminated
Wound class: wound with infarcted or necrotic bowel (non-perforated)
Contaminated
Wound class: open, fresh, accidental wounds
Contaminated
Wound class: major break in sterile technique
Contaminated
Would class: operation entered the respiratory, GI, or genitourniary tract
Clean/ contaminated
Wound from operation that did not enter the resp, GI, or genitourniary tract and shows no sign of infection
Clean
ASA score: The patient was previously healthy and fit
1
ASA score: current smoker
2
ASA score: social alcohol drinker
2
ASA score: pregnant
2
ASA score: obesity
2
ASA score: well-controlled diabetes melitus
2
ASA score: well controlled hypertension
2
ASA score: mild lung disease
2
ASA score: the patient has mild systemic controlled disease
2
ASA score: the patient has severe, but not incapacitating systemic disease
3
ASA score: patient has substanive functional limitations
3
ASA score: patient has one or more moderate to severe disease
3
ASA score: poorly controlled diabetes
3
ASA score: poorly controlled hypertension
3
ASA score: COPD
3
ASA score: morbid obesity
3
ASA score: active hepatitis
3
ASA score: alcohol dependence
3
ASA score: implanted pacemaker
3
ASA score: moderate reduction of ejection fraction (systolic heart failure)
3
ASA score: end-stage renal disease undergoing regular dialysis
3
ASA score: myocardial infarction (heart attack) > 3 months ago
3
ASA score: CVA (cerebrovascular accident or stroke) > 3 months ago
3
ASA score: transient ischemic attack (TIA AKA mini-stroke) > 3 months ago
3
ASA score: coronary artery disease (CAD) or stent > 3 months ago
3
ASA score: patient has incapacitating systemic disease
4
ASA score: recent myocardial infarction (heart attack) in last 3 months
4
ASA score: CVA (cerebrovascular accident or stroke) in last 3 months ago
4
ASA score: transient ischemic attack (TIA AKA mini-stroke) within 3 months
4
ASA score: coronary artery disease (CAD) or stent within 3 months
4
ASA score: ongoing cardiac ischemia or severe valve dysfunction
4
ASA score: severe reduction of ejection fraction (systolic heart failure)
4
ASA score: sepsis
4
ASA score: Disseminated intravascular coagulation (DIC) (blood clots)
4
ASA score: ARDS (acute respiratory distress syndrome)
4
ASA score: end stage renal disease (ESRD)
4
ASA score: the patient is moribund and not expected to survive 24 hours
5
ASA score: ruptured abdominal/ thoracic aneurysm
5
ASA score: massive trauma
5
ASA score: intracranial bleed with mass effect
5
ASA score: ischemic bowel in the face of significant cardiac pathology (blood flow to bowel completely blocked)
5
ASA score: multiple organ/ system dysfunction
5
Closure technique: closure of skin during original surgery (any portion of incision by any manner, even if there are drains)
Primary closure
Closure technique: closure of wound in way that leaves the skin completely open following surgery (may be packed with guaze)
Non-primary closure
Closure technique: laparotomy in which the incision was closed to the level of the deep tissue layers, sometimes called the fascial layers, but the skin level was left open
non-primary closure
Closure technique: the abdomen was left completely open after the surgery (open abdomen)
non-primary closure
What is the most common HAI - making up 32% of HAIs?
Pneumonia
Infection present day of admission (day 1), 2 days before admission, and 1 calendar day after admission
Present on Admission
How long must a patient be on mechanical ventilation for VAP?
> 2 calendar days
Definition PNU-2 (Pneumonia with common bacterial, fungal, or viral pathogens
- Imaging test evidence
- AND Clinically defined signs and symptoms
- AND specific lab findings
Definition PNU-1 (pneumonia based on clinical findings
- imaging test evidence
- AND clinically defined signs and symptoms
What would show up on test imaging for VAP?
- infiltrate (substance that’s denser than air, such as blood, pus, or protein, that lingers in the lungs)
- consolidation (fluid replaces air in lungs)
- cavitation (gas-filled area in the center of a lung nodule)
- pneumatoceles (air filled cysts)
How many chest images does a patient with underlying disease need to meet NHSN’s VAP definition? A healthy patient?
2 for patient with underlying disease
1 for healthy patient
NHSN- need at least one of these key symptoms for VAP classification in people > 1 year
1) Fever
2) Leukopenia or leukocytosis (>1 year, 12k)
3) Altered mental status with no other cause
NHSN- Need at least two of the following symptoms for VAP in anyone >1 (in addition to fever, leukopenia or leukcytosis, or altered mental status) in people >1 year
- new or worsening sputum, increased secretions or suctioning
- new or worsening cough, dypsnea, tachpnea
- rales or bronchial breath sounds
- worsening gas exchange (ie increased O2 demand)