EXAM 2 Healthcare Associated Infections Flashcards
what type of infection is acquired during an acute care hospitalization (>48-72 hours following admission; excludes incubating at admission)?
nosocomial infection
what type of infection is acquired during the course of receiving healthcare treatment, and involves broad exposure (long term care facility, dialysis, home parenteral therapy, etc.)?
healthcare associated infection
the healthcare system includes what 4 facilities?
- acute cair facility
- long term care facility
- ambulatory facility
- home care
what is described as the presence or carriage of microorganisms on a body surface without causing disease (ex. MRSA nasal carriage)
colonization
what is describe as the invasion of body tissues by microorganisms resulting in disease (clinical signs and symptoms) (ex. MRSA blood stream infection)?
infection
what are the top 5 major sites of infection of HAIs in US acute care settings?
- pneumonia
- surgical site infections from any inpatient surgery
- GI illness
- urinary tract infections
- primary bloodstream infections
what is the total estimated number of infections in hospitals in 2011?
721,800
describe types of organisms that cause HAIs in healthcare settings
- exogenous vs. endogenous sources
- pathogenic vs. commensal
- multidrug resistant organisms (MDRO)
- selection for due to antibiotic exposure
- shared via cross-transmission
how many deaths were associated with HAIs in US acute care settings in 2011?
75,000
what are the leading organisms that cause HAIs in US acute care hospitals?
from most common to least:
- c. difficile
- s. aureus (includes MRSA)
- klebsiella spp. (includes carbapenem resistant enterobacteriaceae [CRE])
- e. coli (includes CRE)
- enterococcus spp. (includes vancomycin resistant enterococcus [VRE])
- p. aeruginosa
- candida spp.
- streptococcus spp.
- coagulase neg. staphylococcus (commensal usually resistant to methicillin)
- enterobacter spp. (includes CRE)
- stenotrophomonas maltophilia
- proteus mirabilis
- acinetobacter baumannii (includes carbapanem resistant a. baumannii [CRABB])
c. difficile is responsible for ___ infections per year, ___ deaths per year, and $___ in excess medical costs per year
- 250,000
- 14,000
- $1 billion
what is the chain of infection that represents the infection process? what things can be controlled?
- each link must be present and in order for infection to occur
- can control transmission and portal of entry
why are hospitalized patients at high risk?
- exposure to exogenous organisms from:
- healthcare worker behavior (ex. poor hand hygiene)
- contaminated shared equipment
what are the WHO “5 moments for hand hygiene”?
- before touching a patient
- before clean/aseptic procedure
- after body fluid exposure risk
- after touching a patient
- after touchign patient surroundings
what are the standard body substance precautions?
- hand hygiene with all patient contact
- wear the appropriate PPE determined by nature of interaction and anticipated body fluid exposure
which organisms can be transferred via direct and indirect contact?
- MRSA
- VRE
- CRE
- c. difficile
- norovirus
- RSV
- *wear gown and gloves*
which organisms are transferred via droplets or splashes?
- neisseria meningitidis
- pertussis
- group A strep
- h. influenza
- influenza
- RSV
- other respiratory viruses
- *wear mask and protective eye wear*
which organisms have airborne transmission?
- tuberculosis
- chicken pox
- measles
- influenza?
- SARS?
- *wear mask and protective eye wear (can wear powered air purifying respirator [PAPR])
why are hospitalized patients at high risk?
- interventions give endogenous organisms the opportunity to invade
- surgery
- invasive devices - urinary catheter, vascular catheter, ventilators
what organisms are responsible for central line associated bloodstream infections (CLABSI)?
coagulase negative staphylococcus, s. aureus, enterococcus, candida > gram negatives
how can CLABSI be prevented?
- insertion
- need for catheter?
- maximum sterile barrier precautions
- chlorhexidine prep
- antimicrobial coated catheter
- hand hygiene
- maintenance
- scrub the hub
- intact and clean dressing
- tubing changes
- chlorhexidine sponge
- hand hygiene
what are 3 considerations for infection prevention in dental settings?
- bloodblorne pathogen exposures
- sterilization and disinfection
- dental unit water quality
which 3 bloodborne viruses are transmissible in healthcare settings, can produce chronic infection, and are often carried by persons unaware of their infection?
- hep B
- hep C
- HIV
describe the risk of bloodborne exposure in the dental setting
- includes bodily fluids that can be contaminated with blood (including saliva without blood)
- type of exposure is important (needlestick vs. contact with intact skin)
describe the transmission of hep B from infected dental healthcare personell to patients
- 9 clusters of transmission from dentists and oral surgeons to >300 pateints, 1970-1987
- 8 dentists tested for HBeAg (hep B antigen) were positive
- lack of documented transmissions since 1987 may reflect increased use of gloves and vaccine
- one case of patient-to-patient transmission in 2003
describe hep C infection in dental settings
- inefficiently transmitted by occupational exposures
- prevalence of hep C infection among dentists similar to general population (1-2%)
- no reports of hep C transmission from infected dental healthcare personnel to patients or from patient to patient
- risk of hep C transmission appears very low
describe transmission of HIV in healthcare settings
- from infected dentists to patients
- only 1 documented setting of HIV from an infected dentist to 6 of his 1100 patients
- no other documented transmission in investigations of >22,000 patients of 63 HIV-infected healthcare personnel
what is the bloodborne pathogen risk and potential prophylaxis for hep B?
- 30% from a needle stick (10% chronic infection)
- effective vaccine
- effective post exposure treatment
what is the bloodborne pathogen risk and potential prophylaxis for hep C?
- 3% from a needle stick (85% chronic infection)
- no vaccine
- no good post exposure (treat if become infected)
what is the bloodborne pathogen risk and potential prophylaxis for HIV?
- 0.3% from a needle stick (100% chronic infection)
- no vaccine
- effective post exposure treatment (treat ASAP)
