HAIs and IPC

Question 1

Which conditions are NOT HAIs?

Answer 1

1. Already present on admission
2. Transplacental infections <48h after birth
3. Reactivation of latent infection
4. Colonisation
5. Inflammation

Question 2

What is the Date of Event (DOE) for Surgical Site Infections (SSIs)?

Answer 2

Date when the 1st element used to meet SSI infection criterion occurs for 1st time during SSI surveillance period

Question 3

What are the criteria for a BSI to be determined to be secondary to an SSI?

Answer 3

1. > 1 organism from the specimen matches an organism from the site used to meet SSI criterion AND blood specimen is collected during the secondary BSI attribution period
   OR
2. Organism identified in the blood is an element used to meet the organ/space SSI site-specific infection criterion AND is collected during timeframe for SSI elements

Question 4

What is the secondary BSI attribution period

Answer 4

17d period including SSI DOE, 3 days prior and 13 days after

Question 5

What are the criteria for a superficial incisional SSI?

Answer 5

1. DOE within 30d following operation
   AND
2. Involves only skin and subcutaneous tissue of infection
   AND
3. Patient has at least 1 of the following
   - purulent drainage from incision
   - organism from aseptic specimen from incision
   - superficial incision is opened by surgeon/physician AND patient has localised pain, swelling, erythema, or heat
   - diagnosis by a physician

Question 6

What are the 2 specific types of superficial incisional SSIs?

Answer 6

1. Superficial incisional primary (SIP)
2. Superficial incisional secondary (SIS)

Question 7

Define a superficial incisional primary SSI

Answer 7

Superficial incisional SSI that is identified in primary incision in patient with one or more incisions

Question 8

Define a superficial incisional secondary SSI

Answer 8

Superficial incisional SSI that is identified in secondary incision in patient with >1 incision

Question 9

Which conditions do not qualify to meet the criteria of superficial incisional SSI?

Answer 9

1. Cellulitis diagnosis
2. Stitch abscess alone
3. Localised stab wound or pin site infection

Question 10

Is a laparoscopic trocar site considered a surgical incision or a stab wound?

Answer 10

Surgical incision

Question 11

What are the criteria for a deep incisional SSI?

Answer 11

1. DOE within 30d following operation
   AND
2. Involves deep soft tissues of incision
   AND
3. Patient has at least 1:
   - purulent drainage
   - deep incision deliberately opened by surgeon/physician with organism identified and patient has fever or localised pain
   - abscess or other evidence of infection

Question 12

What are the criteria for an organ/space SSI?

Answer 12

1. DOE within 30 or 90d following operation
   AND
2. Involves deep soft tissues
   AND
3. Patient has at least 1:
   - purulent drainage
   - organism identified
   - abscess or evidence of infection
   AND
4. Meets are least 1 criterion for a specific organ/space infection

Question 13

What are the criteria for Lab Confirmed BSI 1?

Answer 13

1. Not on commensal list
2. Identified by blood culture
3. Identified by NCT (not collected within 2d before or 1d after)
4. Organism not related to another site infection

Question 14

What are the criteria for Lab Confirmed BSI 2?

Answer 14

1. Symptoms
2. Not related to another site infection
3. Commensal identified from >1 blood specimen on separate occasions

Question 15

What are the criteria for VAP?

Answer 15

1. Continuous assisted ventilation through tracheostomy or ETT
2. Infection 48h after intubation or within 48h post removal
3. Diagnosis of pneumonia based on clinical and radiological features

Question 16

What is the Infection Window Period (IWP)?

Answer 16

7d period where all site specific criterion must be met including
- date of 1st positive test
- 3d before
- 3d after

Question 17

What are the criteria for symptomatic UTI (SUTI) 1a?

Answer 17

Catheter in place + SS + culture

1. Catheter >2d on DOE
2. Catheter present on DOE OR removed 1d before DOE
3. Patient symptomatic
4. Urine culture with maximum 2 organisms and > 10*5 CFU

Question 18

What are the criteria for SUTI 1b?

Answer 18

No catheter + SS + culture

1. No catheter or <2d DOE
2. Symptomatic
3. Urine culture with maximum 2 organisms with > 10*5 CFU

Question 19

What are the components of the SSI bundle?

Answer 19

1. Appropriate prophylaxis
2. Appropriate hair removal
3. Post-op glucose control (major cardiac)
4. Post-op normothermia (open abdomen)

Question 20

Which is better to prevent CLRBSIs, chlorhexidine skin prep or povidone-iodine?

Answer 20

Chlorhexidine

Question 21

How often should you replace gauze dressings on short-term CVC sites?

Answer 21

2d

Question 22

How often should you replace transparent dressings on short-term CVC sites?

Answer 22

7d

Question 23

What are the components of the VAP bundle?

Answer 23

1. Elevation of head of bed to 30-45 degrees
2. Oral care w/ 0.12% chlorhexidine solution every 4h daily
3. Daily sedation vacation
4. PUD prophylaxis
5. DVT prophylaxis

Question 24

Name appropriate indications for indwelling catheter use

Answer 24

1. Acute urinary retention or bladder outlet obstruction
2. Protection of SSIs
3. Stage 3/4 sacral or perineal wounds in incontinent patients
4. To improve comfort in palliative care

Question 25

Name inappropriate indications for indwelling catheter use

Answer 25

1. Substitute for nursing care
2. Immobile patient
3. Family request

Question 26

Name the factors of urine catheter maintenance

Answer 26

1. Maintain unobstructed urine flow
2. Bag below level of bladder without resting on floor
3. Closed drainage system
4. Empty regularly
5. Keep under 3/4 full
6. Label individual collection containers
7. Do not let spigot touch container or floor
8. Attach tubing to leg
9. Hand hygiene before and after catheter contact
10. Daily perineal care and when soiled
11. Review catheter necessity and remove promptly