HAI & Antibiotics (Mordecai) Exam II Flashcards
What is a nosocomial infection?
a) An infection that occurs after hospital discharge
b) An infection that is acquired in the hospital
c) An infection present at the time of hospital admission
d) An infection caused by patient’s prior medical history
b) An infection that is acquired in the hospital.
Select 2
True or Flase
A nosocomial infection is when a patient has been admitted to a hospital and a infection is present or incubating at admission.
False
A nosocomial infection is when a patient has been admitted to a hospital and a infection is NOT present or incubating at admission.
Select 2
According to the CDC, how many hospitalized patients are affected by nosocomial infections?
a) 1 in 10
b) 1 in 31
c) 1 in 100
d) 1 in 50
b) 1 in 31
Select 3
Which source of hospital-acquired infections is commonly associated with ICU patients?
a) Clostridium difficile infections
b) Surgical site infections
c) Central line-associated sepsis
d) Urinary catheter-associated UTI
c) Central line-associated sepsis
M - central line associated sepsis is a big one…we see a lot of our ICU patients where bacteria colonizes on the lines…on top of that, these patients are immunocompromised and fighting off other illnesses and traumas in their bodies, so they’re associated with a higher rate of infection
Slide 4
What percentage of hospital-acquired infections is due to urinary catheter-associated UTIs?
a) 12.9%
b) 21.8%
c) 10.5%
d) 15.3%
a) 12.9%
M - not everyone that you put to sleep is going to get a Foley catheter…if the procedure is under two hours, generally, we just have them void before we take them back to surgery and avoid that Foley catheter **altogether.
Slide 4
Which of the following infections is associated with ventilated ICU patients?
a) Surgical site infections
b) Ventilator-associated pneumonia
c) Urinary catheter-associated UTI
d) Clostridium difficile infections
b) Ventilator-associated pneumonia (VAP)
M- with the ICU long -term ventilated patients, we do a lot of sedation vacations, a lot of things to promote endogenous respiratory effort…the practice has moved more towards the use of dexaminetomidine over propofol to kind of keep that respiratory drive as much as possible and get the patients back and not ventilator dependent.
Slide 4
Surgical site infections account for approximately what percentage of hospital-acquired infections?
a) 12.9%
b) 22.5%
c) 21.8%
d) 15.4%
c) 21.8%
Slide 4
Clostridium difficile infections account for what percentage of hospital-acquired infections?
a) 12.1%
b) 21.8%
c) 15.6%
d) 10.2%
a) 12.1%
Slide 4
What two sources account for approximately 21.8% of hospital-acquired infections? Select 2
a) Surgical site infections
b) Ventilator-associated pneumonia
c) Urinary catheter-associated UTI
d) Clostridium difficile infections
e) Hospital-aquired pneumonia
a) Surgical site infections
e) Hospital-aquired pneumonia
Slide 4
Which of the following is a major risk factor for hospital-acquired infections?
a) Short hospital stay
b) Infection control practices
c) Younger age
d) Med Surg unit stays
b) Infection control practices
M - Infection control practices, so whether or not PPE is appropriately being utilized… properly donning and dispose of it without contaminating anything
Slide 5
Which of the following patient populations are at increased risk of contracting a hospital-acquired infection? Select 3
a) Elderly patients
b) Multiple chronic illness patients
c) Young, healthy adults
d) Non-invasive airway support
e) Patients in critical care units
f) Strong immune systems
a) Elderly patients,
b) Patients with multiple chronic illnesses,
e) Patients staying in critical care units
Slide 5
Which of the following factors can increase the risk of hospital-acquired infections (HAIs) in patients?
(Select 4)
a) Compromised immune system
b) Less prevalent the pathogens
c) Longer hospital stays
d) More prevalent the pathogens
e) Mechanical ventilatory support
a) Compromised immune system
c) Longer hospital stays
d) More prevalent pathogens in the community
e) Mechanical ventilatory support
Slide 5
Direct contact with ____________ is a common method of transmission of hospital-acquired infections.
a) Contaminated food
b) Healthcare workers
c) Curtains
d) IV poles
b) Direct contact with healthcare workers
M - *at the nurses station.. if there’s contamination, it can just keep on getting passed on and on. It’s kind of hard to stop that cycle. *
Slide 6
Which of the following areas are particularly prone to contamination in patients with invasive lines?
a) Feet
b) Inguinal
c) Axilla
c) Knees
d) Neck
e) Perineal
f) Scalp
b) Inguinal
c) Axilla
e) Perineal
M - a lot of the body areas where invasive lines are located, lack airflow and or hard to keep clean, the bacteria can start to proliferate. Maintaining clean dressings and keeping the patients bathed and can cut down on that bacterial growth.
Slide 6
True or False
Gloves alone don’t prevent contamination
TRUE
What type of bacteria is commonly associated with extraluminal migration along catheters and invasive lines?
a) Escherichia coli
b) Coagulase-negative staphylococci
c) Streptococcus pneumoniae
d) Bacillus anthracis
e) Methicillin-resistant Staphylococcus aureus
b) Coagulase-negative staphylococci (skin flora)
M - *where bacteria travels along the lines and the catheters. *
Slide 6
Which of the following symptoms are suggestive of a pre-existing infection?
(Select 5)
a) Chills
b) Dysuria
c) Hypertension
d) Night sweats
e) Altered mental status
f) Productive cough
g) High blood pressure
a) Chills
b) Dysuria
d) Night sweats
e) Altered mental status
f) Productive cough
Slide 7
Which symptoms could indicate a respiratory infection or pulmonary issue?
(Select 4)
a) Costovertebral tenderness
b) Shortness of breath
c) Clear sputum
d) Night sweats
e) Dysuria
f) Oliguria
g) Suprapubic pain
a) Costovertebral tenderness (CVA) - CVA tenderness can be a sign of: Kidney infections, Inflammation of the tissues around the kidney
b) Shortness of breath
d) Night sweats
g) Suprapubic pain
Slide 7
True or False
Symptoms suggestive of pre-existing infection could be a runny nose and chills
True
Slide 7
Which of the following vital signs may indicate infection?
(Select 4)
a) Hypotension
b) Tachycardia
c) High oxygen saturations
d) Tachypnea
e) Normal blood pressure
f) Low oxygen saturations
g) Bradycardia
a) Hypotension
b) Tachycardia
d) Tachypnea
f) Low oxygen saturations
Slide 8
Which of the following external devices might require evaluation or replacement upon a patient’s admission to the hospital?
(Select 4)
a) Central line
b) Bulb suction drains
c) Foley catheter
d) Insulin pump
e) Chest tube
f) Endotracheal tube
g) Tracheostomy tube
a) Central line
c) Foley catheter
d) Insulin pump
f) Endotracheal tube
Slide 8
When a patient presents with an already placed IV, it is important to evaluate when and where the line was placed to determine if __________ is necessary.
a) Replacement
b) Removal
c) Tapering
d) Addition of new lines
a) Replacement
M - look at how are they placed, where were they placed, how long have they been placed, and oftentimes, we go ahead and have these lines replaced on admission to ensure sterility in our patients.
Slide 8
Which of the following laboratory values might indicate organ dysfunction or infection?
(Select 5)
a) Lactic acid
b) Decreased white blood cell count
c) Prothrombin time
d) BUN
e) Creatinine levels
f) Elevated blood pressure
g) Increased white blood cellc count
a) Elevated lactic acid
c) Elevated prothrombin time
d) Increased BUN
e) Creatinine levels
g) Increased white blood cellc count
slide 9
True or False
Evidence of organ dysfunction could be hypo or hyperglycemia
True
Slide 9
Which of the following is the most precise laboratory test to identify the specific bacteria causing an infection?
a) Lactic acid level
b) White blood cell count (WBC)
c) Blood cultures
d) Blood pressure
c) Blood cultures
Slide 9
Surgical site infections typically occur within how many days after surgery?
a) 7 days
b) 14 days
c) 30 days
d) 60 days
c) 30 days
Slide 11
What percentage of nosocomial infections are surgical site infections?
a) 10%
b) 25%
c) 38%
d) 50%
c) 38%
Slide 11
How much is estimated to be spent yearly due to prolonged recovery and hospitalization from surgical site infections?
a) $1-2 billion
b) $3.5-8 billion
c) $10-12 billion
d) $15-20 billion
b) $3.5-8 billion
slide 11
Which type of surgical site infection is isolated to just the area of the incision?
a) Deep incisional
b) Organ/space
c) Superficial incisional
d) Subcutaneous tissue infection
c) Superficial incisional
Slide 12
Which type of infection involves being in the muscles and tissues surrounding the incision?
a) Organ/space infection
b) Deep incisional infection
c) Superficial incisional infection
d) Muscle abscess
b) Deep incisional infection
M - This is when we start to see like pus and elevated white blood cell counts and things that are more indicative of a more serious infection
Slide 12
An infection that involves any area other than skin and muscle and spaces between organs is referred to as __________.
a) Superficial incisional
b) Deep incisional
c) Organ/space
d) Muscle-related
c) Organ/space
Slide 12
Signs of Surgical Site Infection (SSI) include redness, pain, ______, and ______.
A) Fever, drainage of pus
B) Warmth, itching
C) Fever, numbness
D) Coolness, bruising
A) Fever, drainage of pus
Slide 13
Delayed healing in a surgical wound, along with ______ and ______, may be signs of Surgical Site Infection (SSI).
A) Swelling, warmth
B) Redness, bruising
C) Coldness, itching
D) Discoloration, tingling
A) Swelling, warmth
Slide 13
Which of the following is a potential sign of a Surgical Site Infection (SSI)?
A) Increased blood flow
B) Delayed healing
C) Bruising
D) Numbness
B) Delayed healing
Slide 13
Slide 14
Which of the following bacteria are most commonly associated with Surgical Site Infections (SSI)? Select 3
A) Escherichia coli,
B) Staphylococcus
C) Clostridium
D) Pseudomonas
E) Listeria
F) Bacillus
G) Streptococcus
B) Staphylococcus
D) Pseudomonas
G) Streptococcus
Slide 14
Which type of wound is not inflamed or contaminated; does not involve internal organs and least likely to result in a Surgical Site Infection (SSI)?
A) Dirty wound
B) Contaminated wound
C) Clean wound
D) Clean-contaminated wound
C) Clean wound
Slide 15
A ______ wound involves an internal organ without evidence of infection, while a ______ wound involves an internal organ and has spillage of contents from the organ.
A) Clean-contaminated, dirty
B) Clean-contaminated, contaminated
C) Dirty, clean
D) Clean, clean-contaminated
B) Clean-contaminated, contaminated
Slide 15
What type of wound is described as having a known infection at the time of surgery?
A) Clean-contaminated
B) Contaminated
C) Dirty
D) Clean
C) Dirty
Slide 15
Surgeries lasting longer than ______ hours are more likely to result in infection.
A) 1
B) 4
C) 2
D) 3
C) 2
slide 15
Patients with comorbidities such as ______ and ______ are at higher risk of developing a Surgical Site Infection (SSI).
A) Smoking, diabetes
B) Overweight, youth
C) Elderly, exercise
D) Clean wound, obesity
A) Smoking, diabetes
Slide 15
Which of the following comorbidities increase the risk of Surgical Site Infection (SSI)? (Select 2)
A) Immunocompromised
B) Cancer
C) Smoking
D) Asthma
E) Overweight
A) Immunocompromised
B) Cancer
Slide 15
Which of the following factors are associated with an increased risk of Surgical Site Infection (SSI)? (Select 2)
A) 30 min procedure
B) Emergency surgery
C) Elderly patient
D) Plastic Surgery
B) Emergency surgery
C) Elderly patient
Slide 15
What percentage of Surgical Site Infections (SSIs) may be preventable?
A) 10%
B) 25%
C) 50%
D) 75%
C) 50%
Slide 16
The GRADE approach used in the 2017 guidelines for SSI prevention evaluated the following aspects: (Select 3)
A) Recommendations
B) Development
C) Literature review
D) Diagnostic tests
E) Hypothesis
F) Evaluation
A) Recommendations
B) Development
F) Evaluation
170 studies appraised and synthesized
Systematic Review of the literature from 1998-2014
Slide 17
What does a “1A” grading in the SSI prevention guidelines represent?
A) Strong recommendation with low-quality evidence
B) Weak recommendation
C) Strong recommendation with moderate to high-quality evidence
D) Recommendation required by state/federal regulation
C) Strong recommendation with moderate to high-quality evidence
M - most highly recommended anti-infection measures that we can take…something like giving IV antibiotics is a level 1A highly recommended intervention
Slide 18
Which of the following best describes the 1B grading category?
A) Strongly recommended based on low-quality evidence
B) Required by state or federal regulation
C) Strong recommendation with moderate to high-quality evidence
D) Weak recommendation based on very low evidence
A) Strongly recommended based on low-quality evidence
M - the level of evidence is a little lower, not as great, may have some bias, but still oftentimes used because it doesn’t seem to be harmful, just not as highly associated with eliminating infections
Slide 18
Which of the following represents a “1C” grading?
A) Strong recommendation required by state/federal regulation
B) Weak recommendation
C) Strong recommendation with moderate to high-quality evidence
D) Strong recommendation with low-quality evidence
A) Strong recommendation required by state/federal regulation
Slide 18
A “II” grade recommendation for SSI prevention is characterized by:
A) Strongly recommended by federal regulations
B) Weak recommendation with limited evidence
C) Strong recommendation based on low-quality evidence
D) Required by federal law regardless of evidence
B) Weak recommendation with limited evidence
M - there’s no strong evidence, but we still see type II interventions occurring in practice just because surgeons will sometimes do everything in their power to prevent infection, even if the interventions aren’t necessarily known to be all that helpful.
Slide 18
Which of the following studies were excluded from the SSI prevention guidelines? (Select 3)
A) Studies involving only orthopedic procedures
B) Studies involving only dental procedures
C) Studies involving dirty procedures
D) Studies involving primary closure procedures
E) Studies where SSIs were not reported as outcomes
B) Studies involving only dental procedures
C) Studies involving dirty procedures
F) Studies where SSIs were not reported as outcomes
M - they excluded studies that didn’t have surgical site infections as a reported outcome. And they did not include patients that had dirty procedures…if the patients were dirty to begin with, came in with pre -infected wounds, then those were eliminated from their studies
*Dental or oral health procedures are not considered sterile, and so they would skew the results. *
Slide 19
Which of the following exclusion criteria were applied in the development of the SSI prevention guidelines? (Select 2)
A) Use of wound protectors post-incision
B) Procedures with no primary closure
C) Clean procedures with primary closure
D) Studies reporting SSI outcomes
A) Use of wound protectors post-incision
B) Procedures with no primary closure
M - So if the wound was left open, it’s obviously going to be more likely to be infected, a more vulnerable situation…and with wound vacs
Slide 19
When should parenteral antibiotics be administered before surgery?
A) Only when indicated
B) Always, regardless of the procedure
C) After the incision has been made
D) Only in emergency cases
A) Only when indicated (SCIP Protocol)
Slide 20
What grade of recommendation is given to the practice of administering parenteral antibiotics before surgery?
A) 1A
B) 2C
C) 1B
D) II
C) 1B
Strongly recommended based on low-quality evidence
Slide 20
The timing of administering parenteral antibiotics should ensure the agent is established in the tissue:
A) Immediately after surgery
B) Before anesthesia
C) Upon incision
D) During post-op recovery
C) Upon incision
M - generally within 30 minutes of incision.
Slide 20
Which of the following is NOT recommended for use in surgical incisions?
A) Saline irrigation with antibiotics
B) Antibiotic ointments
C) Dry dressings
D) Sterile closure techniques
B) Antibiotic ointments (1B)
Dry incisions are better.
Slide 21
True or False
There are strict recommendations and guidlines for antibiotic irrigation and soaking prosthetic devices in antibiotic solution to help prevent infection.
FALSE
M - there’s no recommendations for soaking prosthetic devices in antibiotic solution. No known benefit based on the research, but also probably not harmful. We do still see that.
Slide 21
What is the grade of evidence for perioperative glycemic control?
A) 1A
B) 2B
C) 1B
D) 2A
A) 1A
strongly recommended; moderate-to high quality of evidence
M - it’s becoming common practice to check everybody’s blood sugar within 30 minutes after putting them to sleep and making sure that they’re in that target range…and if not, then you do your interventions and you continue to check it every 30 minutes
Slide 22
What is the recommended perioperative glucose target for blood sugar control?
A) Less than 100 mg/dL
B) Less than 150 mg/dL
C) Less than 200 mg/dL
D) Less than 250 mg/dL
C) Less than 200 mg/dL (1A)
Slide 22
Match each cephalosporin to its appropriate generation:
- Cefazolin – A. First Generation
- Ceftriaxone – C. Third Generation
- Cefepime – D. Fourth Generation
- Cefuroxime – B. Second Generation
- Cefotaxime – C. Third Generation
- Cefoxitin – B. Second Generation
- Ceftazidime – C. Third Generation
- Cefotetan – B. Second Generation
Slide 37
Waiting for verificaiton from Mordecai
Which of the following cephalosporins do NOT penetrate the blood-brain barrier? (Select all that apply)
A) Cefazolin (Ancef)
B) Cefuroxime (Ceftin)
C) Cefoxitin (Mefoxin)
D) Cefotetan (Cefotan)
E) Ceftriaxone
A) Cefazolin (Ancef)
B) Cefuroxime (Ceftin)
C) Cefoxitin (Mefoxin)
D) Cefotetan (Cefotan)
Slide 37
Waiting for verificaiton from Mordecai
Cefazolin is primarily used to treat which of the following conditions? (Select all that apply)
A) Cellulitis
B) Abscesses
C) Upper respiratory infections
D) Urinary tract infections
E) Meningitis
A) Cellulitis
B) Abscesses
C) Upper respiratory infections
D) Urinary tract infections
Most gram + (staph and streptococci)
Slide 37
Waiting for verificaiton from Mordecai
Cefuroxime is effective in treating which of the following conditions? (Select all that apply)
A) H. influenzae pneumonia
B) Urinary tract infections
C) Meningitis
D) Otitis media
A) H. influenzae pneumonia
B) Urinary tract infections
D) Otitis media
Better gram – coverage
Slide 37
Waiting for verificaiton from Mordecai
Which of the following cephalosporins can cross the blood-brain barrier to some extent? (Select all that apply)
A) Ceftriaxone
B) Cefotaxime
C) Cefuroxime
D) Ceftazidime
A) Ceftriaxone
B) Cefotaxime
D) Ceftazidime
Slide 37
Waiting for verificaiton from Mordecai
Cefotaxime is most commonly used to treat which of the following conditions?
A) Gonorrhea
B) Urinary tract infections
C) Meningitis
D) Otitis media
C) Meningitis
Slide 37
Waiting for verificaiton from Mordecai
What drug was noted for treatment of gonorrhea?
A) Cefazolin
B) Cefepime
C) Ceftriaxone
D) Cefoxitin
C) Ceftriaxone
Slide 37
Waiting for verificaiton from Mordecai
What generation of cephalosporins penetrate the blood brain barrier well?
A) Cefazolin
B) Cefepime
C) Ceftriaxone
D) Cefoxitin
B) Cefepime
Most resistant to hydrolysis by β-lactamase.
Reserved for multi-resistant organisms.
Slide 37
What are the most common adverse reactions to vancomycin? (Select all that apply)
A) Phlebitis at the injection site
B) Chills and fever
C) Nephrotoxicity
D) “Red man” syndrome
All of the above
Slide 42
What is (essentially) the first line antibiotic for essentially all surgical prophylaxis?
A) Ciprofloxacin
B) Vancomycin
C) Cefazolin
D) Metronidazole
C) Cefazolin
Which of the following Cefazolin doses are correct for the corresponding weight ranges? (Select all that apply)
A) 1g for adults weighing < 80 kg
B) 2g for adults weighing ≥ 120 kg
C) 2g for adults weighing 81-119 kg
D) 1g for adults weighing 81-119 kg
E) 3g for adults weighing ≥ 120 kg
F) 3g for adults weighing 100-119 kg
A) 1g for adults weighing < 80 kg
C) 2g for adults weighing 81-119 kg
E) 3g for adults weighing ≥ 120 kg
Slide 50
What is the recommended administration time for Cefazolin (Ancef) during surgical prophylaxis?
A) 60 minutes
B) 15-20 minutes
C) 3-5 minutes
D) 30 minutes
C) 3-5 minutes
Slide 50
Which of the following antibiotics are administered over 30 minutes? (Select all that apply)
A) Ampicillin
B) Aztreonam (Azactam)
C) Cefotaxime (Claforan)
D) Ciprofloxacin (Cipro)
E) Clindamycin (Cleocin)
F) Ertapenem (Invanz)
G) Gentamicin (Garamycin)
H) Levofloxacin (Levaquin)
I) Metronidazole (Flagyl)
J) Piperacillin with tazobactam (Zosyn)
A) Ampicillin
B) Aztreonam (Azactam
D) Ciprofloxacin (Cipro)
E) Clindamycin (Cleocin)
F) Ertapenem (Invanz)
G) Gentamicin (Garamycin)
H) Levofloxacin (Levaquin)
I) Metronidazole (Flagyl)
J) Piperacillin with tazobactam (Zosyn)
Slide 50
Which of the following antibiotics are administered over 60 minutes? (Select all that apply)
A) Ceftriaxone (Rocephin)
B) Fluconazole (Diflucan)
C) Moxifloxacin (Avelox)
D) Trimethoprim-Sulfamethoxazole (Bactrim)
E) Vancomycin (Vancocin)
C) Moxifloxacin (Avelox)
D) Trimethoprim-Sulfamethoxazole (Bactrim)
E) Vancomycin (Vancocin)
Slide 50
Fluconazole, when used as an antifungal, should be administered over how many minutes?
A) 30 minutes
B) 45 minutes
C) 60 minutes
D) 120 minutes
D) 120 minutes
Slide 50
Which of the following antibiotics are redosed every 4 hours in the operating room? (Select all that apply)
A) Aztreonam 2g (Azactam)
B) Cefazolin 1g (Ancef)
C) Cefuroxime 1.5g (Zinacef)
D) Piperacillin with tazobactam 3.375g (Zosyn)
A) Aztreonam 2g (Azactam)
B) Cefazolin 1g (Ancef)
C) Cefuroxime 1.5g (Zinacef)
Slide 50
Which of the following antibiotics are redosed every 6 hours in the operating room? (Select all that apply)
A) Cefotetan 2g (Cefotan)
B) Clindamycin 900mg (Cleocin)
C) Metronidazole 500mg (Flagyl)
D) Vancomycin 15 mg/kg (Vancocin)
A) Cefotetan 2g (Cefotan)
B) Clindamycin 900mg (Cleocin)
Slide 50
Trimethoprim-Sulfamethoxazole 160 mg/800 mg (Bactrim) is redosed every ________ hours in the OR.
A) Every 2 hours
B) Every 4 hours
C) Every 6 hours
D) Every 8 hours
D) Every 8 hours
Slide 50
