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Principles > Hospital acquired infections > Flashcards

Hospital acquired infections Flashcards

1
Q

Other name for hospital acquired infection

A

Nosocomial acquired infections

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2
Q

What is a nosocompial acquired infection

A

Not present or incubating at time of admission
Break in time in sterile technique, getting from the hospital

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3
Q

Hospital acquired infection frequency

A

1 in 31 hospital patients (CDC)

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4
Q

Sources of HAI and frequency (6)

A

Central line associated sepsis

Urinary catheter associated UTI (12.9%)

Surgical site infections (21.8%)

Hospital-acquired pneumonia (21.8%)

Ventilator-associated pneumonia

Clostridium difficile infections (12.1%)

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5
Q

Risk factors for HAI (8)

A

Patient’s immune status

Infection control practices

Prevalence of certain pathogens in community

Older age

Longer hospital stays

Multiple chronic illnesses

Mechanical ventilatory support

Critical care unit stays

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6
Q

How are HACI transmitted

A

Direct contact with healthcare workers

Contaminated environments

Extraluminal migration

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7
Q

What is extraluminal migration

A

Normal skin flora -> catheters and can go down the catheters to the blood stream
Coag neg staphylococci (skin flora)

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8
Q

Symptoms suggestive of pre-existing infection (10)

A

Subjective fever
Chills
Night sweats
Altered mental status
Productive cough
Shortness of breath
Rebound tenderness
Suprapubic pain
Dysuria
CVA tenderness

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9
Q

Vital signs suggesting infection

A

Hypotension, tachypnea, low saturations, tachycardia

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10
Q

Lines that can contribute to infection (5)

A

Central line
Foley catheter
Insulin pump
Endotracheal tube
Intravenous lines

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11
Q

Labs suggesting infection

A

Lactic acid
Prothrombin time
BUN/Creatinine
Elevated WBC
Hypo/hyperglycemia
Cultures

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12
Q

SSI typically occur within ______ days of surgery

A

30

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13
Q

_________nosocomial infections in surgical patients

A

38%

coming in with no infection and developing infection from the hospital process

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14
Q

________ spent yearly due to prolonged recovery/hospitalization

A

$3.5 to $8 billion spent yearly due to prolonged recovery/hospitalization

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15
Q

What are the three types of SSI

A

Superficial incisional
Deep incisional
Organ or space

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16
Q

infection just in the area of the incision

A

Superficial incisional infection

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17
Q

infection beneath the incision area in muscle and tissues surrounding muscles

A

Deep incisional infection

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18
Q

infection that is any area other than skin and muscle…includes organs or space between organs.

A

Organ or space infection

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19
Q

Signs of SSI (7)

A

Redness
Delayed healing
Fever
Pain
Warmth
Swelling
Drainage of pus (abscess)

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20
Q

Types of common bacteria

A

Staphylococcus
Streptococcus
Pseudomonas

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21
Q

wound with not inflamed or contaminated; don’t involve internal organ

A

clean wound

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22
Q

Types of wounds (4)

A

clean
clean-contaminated
contaminated
Dirty

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23
Q

wound with no evidence of infection; do involve internal organ

A

clean- contaminated wound

deeper wound and has a potential because of increased opening

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24
Q

wound involves internal organ with spillage of contents from the organ

A

contaminated wound

appendicitis that ruptures, bowel or ulcer that ruptured.

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25
Q

wound known infection at time of surgery

A

dirty wound

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26
Q

RISK for SSI (4)

A

types of wound
surgery lasting > 2hrs (more likely to break technique)
Comorbidites
Elderly Emergency or abdominal surgery

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27
Q

Comorbidieites for risk of SSI (5)

A

Overweight, cancer, smoking, immunocompromised, diabetes

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28
Q

Whats the chance of SSI being preventable?

A

Maybe ½ of SSI’s are preventable!!!

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29
Q

1A grading categories

A

strongly recommended; moderate-to high quality of evidence

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30
Q

1 B grading categories

A

strong recommendation; low quality evidence

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31
Q

1 C grading category

A

strong recommendation required by state/federal regulation

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32
Q

II grading category

A

weak recommendation

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33
Q

Parenteral antibiotics and SSIs

A
  1. administer only when indicated (1B)
  2. timed so that agent is established in tissue upon incision (1B)
34
Q

Non-parenteral antibiotics and SSIs

A

No recommendations for antibiotic irrigation

No recommendation for soaking prosthetic devices in antibiotic solution

Should not apply antibiotic ointments to incisions (1B)

35
Q

Glycemic control and SSIs

A

Perioperative control (1A)

Glucose targets < 200 mg/dL (1A)

No recommendation for tighter control

No recommendation for A1C target

36
Q

Normothermia and infection

A

Maintain perioperative normothermia (1A)

No recommendation for strategies to maintain normothermia

37
Q

Oxygenation (Increased FiO2) and SSIs

A

Patients with normal pulmonary function, GETA intraoperative and immediately after extubation (1A) FIO1s in. 80%

No recommendation for increased FiO2 in patients;
Only intraoperatively with GETA
Neuraxial anesthesia
Postoperatively by mask or nasal cannula
No trials r/t percentage/duration/delivery method

38
Q

Antiseptic prophylaxis and SSIs

A

Shower or bathe with soap or antiseptic pm before (IB)

Intraoperative skin preparation with alcohol-based antiseptic (1A)

Consider intraoperative iodine irrigation in deep tissues (II)

39
Q

Where is iodine irrigation in deep tissues not beneficial

A

No benefit intra-peritoneally
No benefit with iodine imbedded adhesive drapes
No benefit soaking prosthetic devices

40
Q

Blood transfusion and SSIs

A

Do not withhold necessary transfusion from surgical patient as a means to prevent SSI (I B)

41
Q

Systemic immunosuppressive therapy and SSis

A

Uncertain benefits/harm with systemic corticosteroids on risk of SSI in joint arthroplasty
Infection most common indication for revision TKA

Uncertain benefit/harm with intra-articular corticosteroids preoperatively in planned joint arthroplasty

42
Q

Goal for preoperative prophylaxis

A

Adequate bactericidal concentration in serum and tissues when incision is made…
MIC: Minimum inhibitory concentration

43
Q

6 general principles of antibiotic prophylaxis

A
  1. should be active against common surgical wound pathogens
  2. proven efficacy in clinical trials
  3. must achieve MIC
  4. shortest possible course effective….ideally 1 dose
  5. newer antibiotics reserved for resistant infections
  6. if everything equal: oldest, cheapest…
44
Q

Antibiotic timing

A

Initiated within 1 hr of incision (30 minutes even better)
Unless vancomycin or fluoroquinolone: initiated within 2 hrs

Completely infused prior to tourniquet use

May hold antibiotics for cultures

45
Q

Redosing for antibiotic

A

Usually given after 2 half-lives or with excessive blood loss

May be re-dosed following cardiopulmonary bypass

Required for prolonged procedures
Drug dependent; usually 2-4 hours while in OR

46
Q

Common surgical antibiotics (5)

A

Beta lactams;
-Penicillins
-Cephalosporins
-Carbapenems

Vancomycin

Aminoglycosides (gentamycin)

Fluoroquinolones (cipro)

Metronidazole (flagyl)

47
Q

Penicillins-Beta Lactams MOA

A

Inhibit bacterial cell wall synthesis

48
Q

Penicillins-Beta Lactam is the DOC for……

A

DOC for streptococci, meningococci, pneumococci
Mostly gram +
Skin infections, catheter infections, URI’s

49
Q

Resistance to Penicillins-Beta Lactams is due to……..

A

Resistance d/t Beta-lactamase enzyme
Reside on outer surface of cytoplasmic membrane

50
Q

Examples of Penicillins-Beta Lactams

A

Penicillin G
Methicillin
Nafcillin
Amoxicillin

51
Q

Adverse reactions with Penicillins-Beta Lactams

A

Hypersensitivity
-History of reaction unreliable
-Skin rashes to anaphylaxis (0.05%)

GI upset (large doses)

Vaginal candidiasis

52
Q

Cephalosporins-Beta lactams MOA

A

More stable against Beta lactamases;
Broader spectrum
Beta-lactam rings bind to Penicillin-binding protein and inhibit the normal activity of the protein (can’t synthesize a bacterial cell wall)

53
Q

Resistance to Cephalosporins-Beta lactams

A

Resistance occurs by protein altering its structure

54
Q

Cephalosporins-Beta lactams is DOC for……

A

DOC for;
Surgical prophylaxis
Can be used with PCN allergy except anaphylaxis

55
Q

Generation 1 cephalosporins

A

Cefazolin- Ancef, Kefzol

Does not penetrate BBB
Most gram + (staph and streptococci)
Cellulitis, abscesses, URI, UTI
Most common surgical prophylaxis

56
Q

Generation 2 Cephalosporins

A

Cefuroxime- Ceftin, Zinacef

Better gram – coverage
H-influenzae pneumonia, UTI, otitis media

Cefoxitin- Mefoxin
Cefotetan- Cefotan

57
Q

Generation 3 cephalosporins

A

Cefotaxime- Claforan
Some cross BBB
Better gram – than before; treats resistance
Meningitis

Ceftriaxone- Rocephin; Gonorrhea

Ceftazidime- Fortaz

58
Q

Generation 4 cephalosporins

A

Cefepime- Maxipime
Most resistant to hydrolysis by lactamases
Usually reserved for multi-resistant organisms
Penetrates BBB well

59
Q

Adverse reactions with Cephalosporins-Beta lactams

A

Hypersensitivity
Uncommon
Rashes, fever, nephritis, anaphylaxis
Potential production deficit of Vitamin K
Common cause of colitis (3rd generation)

Cross reaction approx. 1%
Increased likelihood of rx IF PCN anaphylaxis

For true anaphylaxis, use vancomycin or clindamycin

60
Q

Carbapenem-Beta lactam MOA

A

Good activity against gram – rods (P aeruginosa) and Enterobacter
Can inhibit the beta-lactamase enzyme
Possess the broadest spectrum of activity
Bind to penicillin-binding protein…

61
Q

Carbapenem-Beta lactam used for_____

A

Last line agents
Intra-abdominal, resistant UTI’s, pneumonia

62
Q

Carbapenem-Beta lactam most penetrate ______

A

BBB

63
Q

Examples of Carbapenem-Beta lactam

A

Ertapenem (Invanz)
Meropenem (Merrem)
Imipenem (Primaxin)

64
Q

Adverse reactions to Carbapenem-Beta lactam

A

N/V
Diarrhea
Rashes
Injection site reactions;
IM formulations contain lidocaine…LA allergies?
Decrease valproic acid (Depakote) up to 90%(sz hx don’t give carbopenem to them)

Cross sensitivity to PCN < 1%

65
Q

Vancomycin MOA

A

Inhibits cell wall synthesis

Active against gram + bacteria (too large to penetrate gram – wall)
Only works if bacterial is actively dividing
Is very slow

66
Q

Vancomycin most valuble against_______

A

Most valuable against blood-stream infection and endocarditis
Caused by MRSA

67
Q

Adverse reactions with vancomycin

A

Frequent
Phlebitis at injection site
Chills, fever
Nephrotoxicity
“red man” syndrome

68
Q

Aminoglycosides MOA

A

Inhibit ribosomal proteins and cause mRNA to misread

69
Q

Amionoglycosides are useful in

A

Significant post antibiotic effect

Synergistic with Beta-lactams or vancomycin
Especially useful in enterococcal endocarditis

70
Q

Examples of aminoglycosides

A

Gentamycin

71
Q

Adverse reactions for aminoglycosides

A

Ototoxicity

Nephrotoxicity, In elderly, For more than 5 days, In renal insufficiency, With higher doses, Concurrent with loop diuretics

Curare-like affect

72
Q

Fluoroquinolone MOA

A

Inhibits bacterial DNA protein synthesis

73
Q

Fluoroquinolone Used for

A

Excellent with gram – organisms
UTI, bacterial diarrhea, bone/joint infections

74
Q

Examples of Fluoroquinolone

A

Examples:
Ciprofloxacin (Cipro)
Levofloxacin (Levaquin)

75
Q

Adverse reactions for Fluoroquinolone

A

N/V/D

Prolongation of QT interval

Cartilage damage/tendon rupture
Renal insufficiency
Concurrent steroid use
Advanced age

76
Q

Metronidazole MOA

A

Antiprotozoal /Anaerobic antibacterial

Forms toxic byproducts that cause unstable DNA molecules

77
Q

Metronidazole is indicated for

A

Indicated for:
Intra-abdominal infections
Vaginitis
C-diff

present as superinfections

78
Q

Metronidazole other name

A

(Flagyl)

79
Q

Adverse reactions for Metronidazole

A

Nausea

Peripheral neuropathy In prolonged use

Disulfiram-like effect With alcohol
Flushing, dizziness, HA, chest/abd pain
Hangover

80
Q
A

Principles (34 decks)

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