Healthcare Associated Infections

Question 1

HAI (hospital acquired infections) epidemiology:

Answer 1

Affects 1 in 20 patients
Cost ~$30 billion annually
~100,000 deaths/year

Question 2

Important types of HAI:

Answer 2

1) Central line associated bloodstream infections
2) Catheter associated UTIs
3) Surgical site infections
4) Ventilator associated events
5) MRSA
6) C. diff infection

Question 3

Risk factors for HAIs:

Answer 3

1) Patient characteristics (extreme age, immunocompromised state, underlying disease)
2) Medical procedures and antibiotic use
3) Prolonged hospitalization
4) Behaviors of healthcare workers

Question 4

Hand hygiene:

Answer 4

Alcohol-based handrubs are preferred
Compliance is very poor (<40%)
Factors leading to poor adherence: professional category, hospital ward, time of day/week, type and intensity of patient care, skin irritation, inaccessible hand hygiene supplies, interference with healthcare worker-patient relationship, patient needs higher priority than hand hygiene, wearing gloves, forgetfulness, insufficient time.

Question 5

5 moments of hand hygiene:

Answer 5

Before touching the patient
Before clean/aseptic procedure
After body fluid exposure
After touching the patient
After touching patient surroundings

Question 6

Standard precautions (for ALL patients):

Answer 6

Hand hygiene: 1) before and after patient contact, 2) after contact with bodily fluids, mucous membranes, non-intact skin, 3) after contact with inanimate objects in immediate vicinity of patient
Personal protective equipment: 1) gloves for contact with body fluids, mucous membranes, non-intact skin, 2) gowns and eye/mouth/nose protection for activity likely to generate splash or spray.
Masks during LP to prevent contamination of procedure site.
Respiratory hygiene and cough etiquette.

Question 7

Contact precautions:

Answer 7

Prevent direct and indirect transmission
Requires private room and dedicated equipment
Gown and gloves to enter room
Used with: uncontrolled secretions or excretions, open or draining wounds, colonized or infected with highly resistant pathogen.

Question 8

Droplet precautions:

Answer 8

Prevent large-particle transmission
Requires private room
Surgical mask to enter room
Used with: Influenza, meningitis, pertussis

Question 9

Airborne precautions:

Answer 9

Prevent transmission of droplet nuclei
Requires negative pressure private room
N95 or portable respirator
Used with: TB, chickenpox, measles

Question 10

Antimicrobial Stewardship Program:

Answer 10

Aims to prevent overuse and misuse of antibiotics
Interventions: education, prior approval/formulary restriction, cycling/rotation, audit with feedback, computer assist program.

Question 11

Antimicrobial prophylaxis in surgery:

Answer 11

For clean procedures: Treat for Staph aureus and coagulase-negative staph
For clean-contaminated procedures: Treat for above organisms and GNR and enterococci.
Should be administered <24 hours post-op)
CEFAZOLIN drug of choice for most.

Question 12

Bloodborne pathogens and occupational exposure:

Answer 12

Risk of infection: Hep B > Hep C > HIV

Question 13

Immunizations for Healthcare Workers:

Answer 13

Hepatitis B, Influenza (yearly), MMR, Varicella, Tetanus, Diphtheria, Pertussis