HAI and Infection Control Flashcards
hais are infections that occur in a patient ____ which was ___
occuring during the process of care in a healthcare facility which was not present or incubating at the time of admission
basic epidemiologic pattern of nosocomial infections
- have reservoirs
- exhibit transmission by largely predictable routes
- require susceptible hosts
modes of transmission of hais
- 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)
factors that increase host susceptibility
U AMP
underlying conditions
abnormalities of innate defense
medical-surgical interventions
procedures
formula for hai rate
(total number CASES of device related infection / total number of DAYS associated with the specific hai) x 1000
t/f vap occurs in more than 10% of patients on ventilators
true
most cases of vap/hap are due to __
aspiration of endogenous or hospital acquired oropharyngeal flora
can also be gastric flora
pathogenesis of vap/hap
colonization, migration, aspiration, biofilm formation (on et)
inhalation
risk factors for infection of vap/hap
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
t/f it’s challenging to diagnose vap/hap because they have normal cxrs
false, they already have abnormal cxr so its hard to determine
worsening physiologic parameters are key metrics
risk factors for mortality in vap/hap
- multiple comorbids
- inadequate antibiotic treatment (start therapy within first hr of diagnosis)
- involvement of specific pathogens (p aeruginosa, acinetobacter)
t/f it is advised to do quantitative cultures for vap/hap
true
early onset nosocomial pneumonia occurs ___
first 4 days of intubation/ hospitalization usually caps (s. pneumonia, h. influenzae)
late onset nosocomial pneumonia occurs ___
after first 4 days of intubation / hospitalization
usually g- bacilli (k. pneumoniae, p aeruginosa, acinetobacter) or drug resistant (mrsa)
how many days is duration of treatment for nosocomial pneumonia
8 days
acinetobacter / p aeruginosa: >14 d
differentials for febrile patients on et/gt
bacterial sinusitis
otitis media
t/f cauti infections are reservoirs and sources for spread of antibiotic resistant bacteria
true
pathogenesis of cauti
- spread up periurethral space from perineum or gi tract
- intraluminal contamination of urinary catheters from irrigation / emptying
- inadequately disinfected equipment and contaminated supplies
t/f evidence shows you should irrigate catheters
false!!
alternative catheter for men with no bladder obstruction
condom catheter
rule to prevent cauti
remove the catheter if the patient can void spontaneously
for patients with chronic catheters you must ___
replace the catheter and obtain a freshly voided urine specimen
when to do repeat culture for cauti
1 week after termination of antibiotics
recovery of s aureus from cultures can result from ___ in cauti
hematogenous seeding and occult systemic infection == SEEK A SOURCE
s aureus and mrsa are not common causes of cauti!!
indications for treatment of candiduria
upper pole or bladder wall invasion, obstruction, neutropenia, or immunosuppression
mgt: remove catheter
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
clabsi
pathogens in clabsi have ___ that help them communicate
quorum sensing proteins
diagnosis of clabsi is based on
- appearance of catheter site
- OR presence of fever
- OR bacteremia
- WITHOUT another source
diagnosis of clabsi is confirmed by
- 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
patients with clabsi need to be evaluated for __
s aureus or staph = endocarditis (2d echo)
for suppurative venous thrombophlebitiis ___ is required
excision of affected veins
types of surgical site infections
superficial incisional: subcutaneous tissue
deep incisional: fascia and muscles
organ/space: any part of the body that is deepr than fascia
sources of ssi
- patient’s endogenous or h-a skin flora
- airborne spread of skin squames
- true airborne spread through droplet nuclei (need a disseminator)
common risks for post-op wound infection
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
organ space infections or subphrenic abscesses requite __
prosthetic devices require ___
ct or mri
interventional radiographic techniques
most common pathogens in postop wound infections
s aureus
coagulase negative staph
enteric and anaerobic bacteria
rapidly progressing: gas or clostridium
most important preventive measure
hand hygiene
exceptions to alcohol rubs
hands are visibly soiled
outbreak of c difficile
5 moments of hand hygiene
before touching patient before procedure after procedure after touching patient after touching environment
hap/vap bundle
avoid mechanical ventilation (use cpap) elevate head 30-45 deg decontaminate oropharynx with chlorhexidine sedation vacation dvt prophylaxis
clabsi catheter insertion bundle
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
clabsi catheter maintenance bundle
cleanse daily with chlorhexidine
maintain clean dry dressings
hand hygiene
remove catheter if not needed
cauti bundle
catheter only when needed
aseptic equipment and technique
minimize manipulation
remove if not needed
ssi bundle
choose surgeon
administer prophylactic antibiotics within 1 hr before surgery
limit hair removal
use chlorhexidine-alcohol
indications for contact precautions
for patients with suspected to have serious illness easily transmitted by direct patient contact or by contact with items in pt environment
contact precautions
gown and gloves, mask not needed
indications for airborne precautions
pt known or suspected to have serious illness transmitted by airborne droplet nuclei (measles, varicella, tb, covid)
airborne precautions
well fitted n95 mask, no need for gown and gloves
indications for droplet precautions
serious illness transmitted by large particle droplets (h influenzae type b, n meningitidis, rubella, mumps, influenza)
droplet precautions
surgical mask, no need for n95, gown, gloves
