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12 Infectious Disease > HAI and Infection Control > Flashcards

HAI and Infection Control Flashcards

1
Q

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

A

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

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2
Q

basic epidemiologic pattern of nosocomial infections

A
  • have reservoirs
  • exhibit transmission by largely predictable routes
  • require susceptible hosts
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3
Q

modes of transmission of hais

A
  • 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)
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4
Q

factors that increase host susceptibility

A

U AMP

underlying conditions
abnormalities of innate defense
medical-surgical interventions
procedures

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5
Q

formula for hai rate

A

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

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6
Q

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

A

true

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7
Q

most cases of vap/hap are due to __

A

aspiration of endogenous or hospital acquired oropharyngeal flora

can also be gastric flora

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8
Q

pathogenesis of vap/hap

A

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

inhalation

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9
Q

risk factors for infection of vap/hap

A

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

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10
Q

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

A

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

worsening physiologic parameters are key metrics

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11
Q

risk factors for mortality in vap/hap

A
  • multiple comorbids
  • inadequate antibiotic treatment (start therapy within first hr of diagnosis)
  • involvement of specific pathogens (p aeruginosa, acinetobacter)
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12
Q

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

A

true

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13
Q

early onset nosocomial pneumonia occurs ___

A 
first 4 days of intubation/ hospitalization
usually caps (s. pneumonia, h. influenzae)
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14
Q

late onset nosocomial pneumonia occurs ___

A

after first 4 days of intubation / hospitalization

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

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15
Q

how many days is duration of treatment for nosocomial pneumonia

A

8 days

acinetobacter / p aeruginosa: >14 d

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16
Q

differentials for febrile patients on et/gt

A

bacterial sinusitis

otitis media

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17
Q

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

A

true

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18
Q

pathogenesis of cauti

A
  • spread up periurethral space from perineum or gi tract
  • intraluminal contamination of urinary catheters from irrigation / emptying
  • inadequately disinfected equipment and contaminated supplies
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19
Q

t/f evidence shows you should irrigate catheters

A

false!!

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20
Q

alternative catheter for men with no bladder obstruction

A

condom catheter

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21
Q

rule to prevent cauti

A

remove the catheter if the patient can void spontaneously

22
Q

for patients with chronic catheters you must ___

A

replace the catheter and obtain a freshly voided urine specimen

23
Q

when to do repeat culture for cauti

A

1 week after termination of antibiotics

24
Q

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

A

hematogenous seeding and occult systemic infection == SEEK A SOURCE

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

25
Q

indications for treatment of candiduria

A

upper pole or bladder wall invasion, obstruction, neutropenia, or immunosuppression

mgt: remove catheter

26
Q

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

A

clabsi

27
Q

pathogens in clabsi have ___ that help them communicate

A

quorum sensing proteins

28
Q

diagnosis of clabsi is based on

A
  • appearance of catheter site
  • OR presence of fever
  • OR bacteremia
  • WITHOUT another source
29
Q

diagnosis of clabsi is confirmed by

A
  • 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
30
Q

patients with clabsi need to be evaluated for __

A

s aureus or staph = endocarditis (2d echo)

31
Q

for suppurative venous thrombophlebitiis ___ is required

A

excision of affected veins

32
Q

types of surgical site infections

A

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

33
Q

sources of ssi

A
  • patient’s endogenous or h-a skin flora
  • airborne spread of skin squames
  • true airborne spread through droplet nuclei (need a disseminator)
34
Q

common risks for post-op wound infection

A 
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
35
Q

organ space infections or subphrenic abscesses requite __

prosthetic devices require ___

A

ct or mri

interventional radiographic techniques

36
Q

most common pathogens in postop wound infections

A

s aureus
coagulase negative staph
enteric and anaerobic bacteria

rapidly progressing: gas or clostridium

37
Q

most important preventive measure

A

hand hygiene

38
Q

exceptions to alcohol rubs

A

hands are visibly soiled

outbreak of c difficile

39
Q

5 moments of hand hygiene

A 
before touching patient
before procedure
after procedure
after touching patient
after touching environment
40
Q

hap/vap bundle

A 
avoid mechanical ventilation (use cpap)
elevate head 30-45 deg
decontaminate oropharynx with chlorhexidine
sedation vacation
dvt prophylaxis
41
Q

clabsi catheter insertion bundle

A

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

42
Q

clabsi catheter maintenance bundle

A

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

43
Q

cauti bundle

A

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

44
Q

ssi bundle

A

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

45
Q

indications for contact precautions

A

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

46
Q

contact precautions

A

gown and gloves, mask not needed

47
Q

indications for airborne precautions

A

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

48
Q

airborne precautions

A

well fitted n95 mask, no need for gown and gloves

49
Q

indications for droplet precautions

A

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

50
Q

droplet precautions

A

surgical mask, no need for n95, gown, gloves

12 Infectious Disease (10 decks)

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