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1Fall24 PoA II > HAI & Abx pt1 (Ex2) > Flashcards

HAI & Abx pt1 (Ex2) Flashcards

1
Q

What are significant sources of hospital-acquired infections? (6)

A
  • CVL sepsis
  • UTI 13%
  • SSI 22%
  • HAP 22%
  • VAP
  • C-diff 12%
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2
Q

What contaminated areas increase susceptibility to HAI’s?

A
  • Inguinal
  • Perineal
  • Axilla
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3
Q

What bacteria are your skin flora?

A

Coag neg staphylococci

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4
Q

What labs can be useful for evaluation of HAI’s? (6)

A
  • Lactate
  • PT
  • Bun/Cr
  • WBCs
  • ⇅Blood glucose
  • Cultures

evidence of organ dysfunction

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5
Q

Surgical site infections typically occur within ___ days of surgery.

A

30 days

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6
Q

What are the categories for surgical site infection? (3)

A
  • Superficial = skin & SQ
  • Deep = fascia & muscle
  • Organ/Space
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7
Q

What are the three most common types of bacteria associated with surgical site infections?

A
  • Staphylococcus
  • Streptococcus
  • Pseudomonas
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8
Q

How would a wound that is not inflamed or contaminated and does not involve internal organs be categorized?

A

Clean

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9
Q

How would a wound that has no outward signs of infection but does involve internal organs be categorized?

A

Clean-Contaminated

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10
Q

How would a wound that involves internal organ infection along with spillage of contents into surrounding tissue be categorized?

A

Contaminated

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11
Q

What is an example of contaminated SSI?

A

Ruptured appendix

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12
Q

How is a Dirty SSI defined?

A

Known infection at the surgical site at the time of the surgery.

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13
Q

What are risks factors for SSI? (5)

A
  • > 2hr surgery
  • Comorbidities (smoker, DM, cancer, obese, etc)
  • Elderly
  • Emergency surgery
  • Abdominal surgery
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14
Q

Potentially ___% of SSI’s are preventable.

A

50%

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15
Q

What is a category 1A recommendation?

A

1A = Strongly recommended; moderate to high quality of evidence

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16
Q

What is a category 1B recommendation?

A

1B = Strongly recommended; low quality evidence

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17
Q

What is a category 1C recommendation?

A

1C = Strong recommendation based on state/federal regulation

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18
Q

What is a category II recommendation?

A

Weak recommendation

19
Q

What exclusions were there to the Guideline for Prevention of SSI’s? (5)

A
  • SSI not a reported outcome
  • All patients w/ “dirty procedures”
  • No dental or oral health procedures
  • Procedures that did not have primary closure
  • Study included wound protectors post-incision
20
Q

What are the recommendations for parenteral antibiotics? (2)

A

1B - Administer only when indicated
1B - Time so that agent is active on tissue incision

21
Q

What are the recommendations for non-parenteral antibiotics?

A

1B - no antibiotic ointment on incision

Dry incisions are better.

22
Q

What recommendations are there for antibiotic irrigation and prosthetic soaking in antibiotic solution?

A

No recommendations on prosthetic soaking in abx solution or abx irrigation

23
Q

What are the 1A recommendation levels for glycemic control?

A
  • Perioperative control of glucose
  • Target glucose < 200 mg/dL
24
Q

What is the recommendation level for A1C targets?

A

No recommendation for A1C target

Just acute control of BG.

25
Q

Maintaining perioperative normothermia is a ___ recommendation.

A

1A

26
Q

What is the 1A recommendation for oxygenation in GETA patients?

A

↑ FiO₂ intraop and after extubation w/ GETA patients w/ normal pulmonary function.

Recommendation is losing credibility as a way to prevent SSI’s.

27
Q

What are the 1A, 1B, and II recommendations for antiseptic prophylaxis?

A

1A - Intraoperative skin prep w/ alcohol-based antiseptic.
1B - Shower or bathe w/ soap/antiseptic the night before surgery.
II - Consider intraoperative Iodine irrigation.

28
Q

What is the recommendation for blood transfusion?

A

1B - Do not withhold necessary blood transfusions as a means to prevent SSI.

29
Q

Should systemic corticosteroids be utilized in a patient with joint arthroplasty?

A

Uncertain. Infection is most common indication for TKA revision however.

30
Q

What does MIC stand for?

A

Minimum Inhibitory Concentration
-adequate bactericidal concentration in serum and tissues when incision made

31
Q

What are the 6 general principles of preoperative antibiotic prophylaxis?

A
  1. Should be active against common SSI pathogens
  2. Proven efficacy by clinical trials
  3. MIC must be achieved
  4. Shortest possible effective course
  5. New ABX reserved for resistant infections
  6. If possible, use oldest/cheapest ABX
32
Q

ABX should be initiated within ____ hour of incision.

A

1 hour (30 min even better)

33
Q

_________ and _________ can be initiated within 2 hours of incision.

A

Vancomycin and Fluoroquinolones (like Cipro)

34
Q

Can antibiotics be held for cultures?

A

yes

35
Q

ABX must be completely infused prior to use of a __________. Why?

A

Tourniquet
-To make sure concentration gets to that tissue.

36
Q

Re-dosing parameters of antibiotics consists of what conditions? (4)

A
  • 2 ABX half-lives
  • Excessive blood loss
  • Cardiac bypass
  • Prolonged procedures (usually 2-4 hours in OR)
37
Q

What drug classes are β-lactam based?

A
  • Penicillins
  • Cephalosporins
  • Carbapenems
38
Q

What are the 5 major common surgical antibiotics?

A
  • β-lactams
  • Vancomycin
  • Aminoglycosides (gentamycin)
  • Fluoroquinolones (cipro)
  • Metronidazole (flagyl)
39
Q

How do Penicillin β-lactam antibiotics work?

A

Inhibition of bacterial cell wall synthesis

40
Q

Resistance to Penicillin β-lactam antibiotics is based on what?

A

β-lactamase enzyme on outer surface of cytoplasmic membrane

41
Q

Penicillin β-lactams are the drug of choice for what pathogens?

A

Gram + Bacterium (Cocci)

  • Streptococci
  • Meningococci
  • Pneumococci
42
Q

β-lactams are good for which HAI’s?

A

skin, catheter, and upper respiratory infections

43
Q

What four examples of penicillin based antibiotics were given?

A
  • Penicillin G
  • Methicillin
  • Nafcillin
  • Amoxicillin

.

44
Q

What are three common adverse reactions to penicillin β-lactams?

A
  • Hypersensitivity (includes anaphylaxis 0.05%)
  • GI upset
  • Vaginal Candidiasis

1Fall24 PoA II (34 decks)

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