HAI and Infection Control

Question 1

hais are infections that occur in a patient ____ which was ___

Answer 1

occuring during the process of care in a healthcare facility which was not present or incubating at the time of admission

Question 2

basic epidemiologic pattern of nosocomial infections

Answer 2

• have reservoirs
• exhibit transmission by largely predictable routes
• require susceptible hosts

Question 3

modes of transmission of hais

Answer 3

• cross infection
• autoinoculation
• person to person via large infectious droplets (coughing or sneezing)
• true airborne spread of small droplet nuclei (nosocomial chickenpox)
• common source spread (contaminated iv fluid)

Question 4

factors that increase host susceptibility

Answer 4

U AMP

underlying conditions
abnormalities of innate defense
medical-surgical interventions
procedures

Question 5

formula for hai rate

Answer 5

(total number CASES of device related infection / total number of DAYS associated with the specific hai) x 1000

Question 6

t/f vap occurs in more than 10% of patients on ventilators

Answer 6

true

Question 7

most cases of vap/hap are due to __

Answer 7

aspiration of endogenous or hospital acquired oropharyngeal flora

can also be gastric flora

Question 8

pathogenesis of vap/hap

Answer 8

colonization, migration, aspiration, biofilm formation (on et)

inhalation

Question 9

risk factors for infection of vap/hap

Answer 9

colonies aspirate defense

events that increase colonization by potential pathogens

events that facilitate aspiration of oropharyngeal contents

events that reduce host defense mechanisms in lungs = overgrowth

Question 10

t/f it’s challenging to diagnose vap/hap because they have normal cxrs

Answer 10

false, they already have abnormal cxr so its hard to determine

worsening physiologic parameters are key metrics

Question 11

risk factors for mortality in vap/hap

Answer 11

• multiple comorbids
• inadequate antibiotic treatment (start therapy within first hr of diagnosis)
• involvement of specific pathogens (p aeruginosa, acinetobacter)

Question 12

t/f it is advised to do quantitative cultures for vap/hap

Answer 12

true

Question 13

early onset nosocomial pneumonia occurs ___

Answer 13

first 4 days of intubation/ hospitalization
usually caps (s. pneumonia, h. influenzae)

Question 14

late onset nosocomial pneumonia occurs ___

Answer 14

after first 4 days of intubation / hospitalization

usually g- bacilli (k. pneumoniae, p aeruginosa, acinetobacter) or drug resistant (mrsa)

Question 15

how many days is duration of treatment for nosocomial pneumonia

Answer 15

8 days

acinetobacter / p aeruginosa: >14 d

Question 16

differentials for febrile patients on et/gt

Answer 16

bacterial sinusitis

otitis media

Question 17

t/f cauti infections are reservoirs and sources for spread of antibiotic resistant bacteria

Answer 17

true

Question 18

pathogenesis of cauti

Answer 18

• spread up periurethral space from perineum or gi tract
• intraluminal contamination of urinary catheters from irrigation / emptying
• inadequately disinfected equipment and contaminated supplies

Question 19

t/f evidence shows you should irrigate catheters

Answer 19

false!!

Question 20

alternative catheter for men with no bladder obstruction

Answer 20

condom catheter

Question 21

rule to prevent cauti

Answer 21

remove the catheter if the patient can void spontaneously

Question 22

for patients with chronic catheters you must ___

Answer 22

replace the catheter and obtain a freshly voided urine specimen

Question 23

when to do repeat culture for cauti

Answer 23

1 week after termination of antibiotics

Question 24

recovery of s aureus from cultures can result from ___ in cauti

Answer 24

hematogenous seeding and occult systemic infection == SEEK A SOURCE

s aureus and mrsa are not common causes of cauti!!

Question 25

indications for treatment of candiduria

Answer 25

upper pole or bladder wall invasion, obstruction, neutropenia, or immunosuppression mgt: remove catheter

Question 26

laboratory confirmed blood stream infection in a patient with a central line within 48 hrs before development of bsi and not related to infection at another site

Answer 26

clabsi

Question 27

pathogens in clabsi have ___ that help them communicate

Answer 27

quorum sensing proteins

Question 28

diagnosis of clabsi is based on

Answer 28

- appearance of catheter site - OR presence of fever - OR bacteremia - WITHOUT another source

Question 29

diagnosis of clabsi is confirmed by

Answer 29

- recovery of the same species of pathogenic microorganism from peripheral blood cultures (2 samples) - semiquantitative or quantitative cultures of vascular catheter tip - differential time to positivity (> 2 hrs) for blood drawn through vascular access device than for sample from peripheral vein - difference in quantitative cultures (>threefold) from peripheral and central vein

Question 30

patients with clabsi need to be evaluated for __

Answer 30

s aureus or staph = endocarditis (2d echo)

Question 31

for suppurative venous thrombophlebitiis ___ is required

Answer 31

excision of affected veins

Question 32

types of surgical site infections

Answer 32

superficial incisional: subcutaneous tissue deep incisional: fascia and muscles organ/space: any part of the body that is deepr than fascia

Question 33

sources of ssi

Answer 33

- patient's endogenous or h-a skin flora - airborne spread of skin squames - true airborne spread through droplet nuclei (need a disseminator)

Question 34

common risks for post-op wound infection

Answer 34

``` surgeon's technical skills patient's conditions age inappropriate timing of antibiotic prophylaxis (1 hr before cutting) drains prolonged pre-op stay shaving long surgery infection at remote sites ```

Question 35

organ space infections or subphrenic abscesses requite __ prosthetic devices require ___

Answer 35

ct or mri interventional radiographic techniques

Question 36

most common pathogens in postop wound infections

Answer 36

s aureus coagulase negative staph enteric and anaerobic bacteria rapidly progressing: gas or clostridium

Question 37

most important preventive measure

Answer 37

hand hygiene

Question 38

exceptions to alcohol rubs

Answer 38

hands are visibly soiled | outbreak of c difficile

Question 39

5 moments of hand hygiene

Answer 39

``` before touching patient before procedure after procedure after touching patient after touching environment ```

Question 40

hap/vap bundle

Answer 40

``` avoid mechanical ventilation (use cpap) elevate head 30-45 deg decontaminate oropharynx with chlorhexidine sedation vacation dvt prophylaxis ```

Question 41

clabsi catheter insertion bundle

Answer 41

educate use chlorhexidine to prepare insertion site use maximal barrier precautions and asepsis (covered head to toe with sterile cloth, ppes) consolidate insertion supplies checklist halt insertion if not aseptic

Question 42

clabsi catheter maintenance bundle

Answer 42

cleanse daily with chlorhexidine maintain clean dry dressings hand hygiene remove catheter if not needed

Question 43

cauti bundle

Answer 43

catheter only when needed aseptic equipment and technique minimize manipulation remove if not needed

Question 44

ssi bundle

Answer 44

choose surgeon administer prophylactic antibiotics within 1 hr before surgery limit hair removal use chlorhexidine-alcohol

Question 45

indications for contact precautions

Answer 45

for patients with suspected to have serious illness easily transmitted by direct patient contact or by contact with items in pt environment

Question 46

contact precautions

Answer 46

gown and gloves, mask not needed

Question 47

indications for airborne precautions

Answer 47

pt known or suspected to have serious illness transmitted by airborne droplet nuclei (measles, varicella, tb, covid)

Question 48

airborne precautions

Answer 48

well fitted n95 mask, no need for gown and gloves

Question 49

indications for droplet precautions

Answer 49

serious illness transmitted by large particle droplets (h influenzae type b, n meningitidis, rubella, mumps, influenza)

Question 50

droplet precautions

Answer 50

surgical mask, no need for n95, gown, gloves