Healthcare-Associated Infections

Question 1

What are healthcare-associated infections?

Answer 1

• an infection that is acquired in a hospital or healthcare facility
• acute care = nosocomial, not present or incubating at admission, onset of symptoms > 48 hours after admission, or sxs not present until after DC

Question 2

What percentage of HAI are associated with device use?

Answer 2

> 85%!

BIOFILM!

Question 3

common sites of HAIs

Answer 3

lung > wound > GI > UTI > BSI

Question 4

Sources of infection (4)

Answer 4

1) pt own flora
2) HCW’s hands
3) environment or equipment
4) products

Question 5

common micro found on medical ICU staff hands:

Answer 5

S. aureus
enterococcus
enterobacter
pseudomonas
klebsiella

Question 6

Bacterial contamination increases…

a) linearly w/ time during pt care and number of contacts
b) more with handwashing vs. alcohol hand antisepsis use
c) with glove use
d) a and b
e) all of the above

Answer 6

D — both (a) and (b) are correct

Question 7

five moments of hand hygiene?

Answer 7

1) before patient contact
2) before aseptic tast
3) after body fluid exposure risk
4) after pt. contact
5) after contact w/ pt surroundings

Question 8

Most HA bloodstream infections (>85%) are associated with ____?

Answer 8

Central Lines!!!!

• coag (-) staph
• enterococcus
• candida
• staph aureus

Question 9

5 sources of CLABSI:

Answer 9

1) migration from the catheter-skin interface
2) from the catheter hub
3) hematogenous seeding from catheter tip
4) insertion process
5) infusate contamination

BIOFILM!

Question 10

Preferred sites for CLABSI prevention

Answer 10

subclavian > IJ > femoral

Question 11

Risk factors for CDAD

Answer 11

age, antimicrobial use, use of PPIs, infected roommate, prolonged hospital stay, severe underlying conditions, immunosuppressive rx

Question 12

higher risk antimicrobials (for CDAD)

Answer 12

• 3rd generation cephalosporins
• FQ
• 2nd gen ceph.
• clinda

Question 13

What kind of hand hygiene DOES NOT remove C.diff spores?

Answer 13

alcohol-based hand cleaners

Question 14

Organisms causing SSI:

Answer 14

• s. aureus
• coag neg staph
• enterococcus spp.
• E. coli
• pseudomonas aeruginosa
• candida

Question 15

Treatment for S.aureus to prevent SSI

Answer 15

MRSA (+) or unknown — mupirocin +cefazolin plus vanco
MSSA (+) — mupirocin + cefazolin
no SA — cefazolin

Question 16

Catheter-associated UTI pathogenesis

Answer 16

• endogenous infection (meatal, rectal or vaginal)
• exogenous infection -contaminated HC hands

again, BIOFILM

Question 17

Modifiable Risk Factors for CAUTI:

Answer 17

1) prolonged cath
2) disconnection of drainage system
3) lower professional training of inserter

Question 18

The most common nosocomial infection is ______

Answer 18

HA Pneumonia

*S. aureus, P. aeruginosa, K. pneumoniae

Question 19

Results of the paired sedation & ventilator weaning protocol for mechanically ventilated pts study:
(vs. patient intuition)

Answer 19

• spent more days breathing w/out assistance
• were DCed from ICU earlier
• were DCed from hospital earlier