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Hospital acquired infections Flashcards

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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
wound known infection at time of surgery
dirty wound
26
RISK for SSI (4)
types of wound surgery lasting > 2hrs (more likely to break technique) Comorbidites Elderly Emergency or abdominal surgery
27
Comorbidieites for risk of SSI (5)
Overweight, cancer, smoking, immunocompromised, diabetes
28
Whats the chance of SSI being preventable?
Maybe ½ of SSI’s are preventable!!!
29
1A grading categories
strongly recommended; moderate-to high quality of evidence
30
1 B grading categories
strong recommendation; low quality evidence
31
1 C grading category
strong recommendation required by state/federal regulation
32
II grading category
weak recommendation
33
Parenteral antibiotics and SSIs
1. administer only when indicated (1B) 2. timed so that agent is established in tissue upon incision (1B)
34
Non-parenteral antibiotics and SSIs
No recommendations for antibiotic irrigation No recommendation for soaking prosthetic devices in antibiotic solution Should not apply antibiotic ointments to incisions (1B)
35
Glycemic control and SSIs
Perioperative control (1A) Glucose targets < 200 mg/dL (1A) No recommendation for tighter control No recommendation for A1C target
36
Normothermia and infection
Maintain perioperative normothermia (1A) No recommendation for strategies to maintain normothermia
37
Oxygenation (Increased FiO2) and SSIs
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
Antiseptic prophylaxis and SSIs
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
Where is iodine irrigation in deep tissues not beneficial
No benefit intra-peritoneally No benefit with iodine imbedded adhesive drapes No benefit soaking prosthetic devices
40
Blood transfusion and SSIs
Do not withhold necessary transfusion from surgical patient as a means to prevent SSI (I B)
41
Systemic immunosuppressive therapy and SSis
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
Goal for preoperative prophylaxis
Adequate bactericidal concentration in serum and tissues when incision is made… MIC: Minimum inhibitory concentration
43
6 general principles of antibiotic prophylaxis
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
Antibiotic timing
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
Redosing for antibiotic
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
Common surgical antibiotics (5)
Beta lactams; -Penicillins -Cephalosporins -Carbapenems Vancomycin Aminoglycosides (gentamycin) Fluoroquinolones (cipro) Metronidazole (flagyl)
47
Penicillins-Beta Lactams MOA
Inhibit bacterial cell wall synthesis
48
Penicillins-Beta Lactam is the DOC for......
DOC for streptococci, meningococci, pneumococci Mostly gram + Skin infections, catheter infections, URI’s
49
Resistance to Penicillins-Beta Lactams is due to........
Resistance d/t Beta-lactamase enzyme Reside on outer surface of cytoplasmic membrane
50
Examples of Penicillins-Beta Lactams
Penicillin G Methicillin Nafcillin Amoxicillin
51
Adverse reactions with Penicillins-Beta Lactams
Hypersensitivity -History of reaction unreliable -Skin rashes to anaphylaxis (0.05%) GI upset (large doses) Vaginal candidiasis
52
Cephalosporins-Beta lactams MOA
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
Resistance to Cephalosporins-Beta lactams
Resistance occurs by protein altering its structure
54
Cephalosporins-Beta lactams is DOC for......
DOC for; Surgical prophylaxis Can be used with PCN allergy except anaphylaxis
55
Generation 1 cephalosporins
Cefazolin- Ancef, Kefzol Does not penetrate BBB Most gram + (staph and streptococci) Cellulitis, abscesses, URI, UTI Most common surgical prophylaxis
56
Generation 2 Cephalosporins
Cefuroxime- Ceftin, Zinacef Better gram – coverage H-influenzae pneumonia, UTI, otitis media Cefoxitin- Mefoxin Cefotetan- Cefotan
57
Generation 3 cephalosporins
Cefotaxime- Claforan Some cross BBB Better gram – than before; treats resistance Meningitis Ceftriaxone- Rocephin; Gonorrhea Ceftazidime- Fortaz
58
Generation 4 cephalosporins
Cefepime- Maxipime Most resistant to hydrolysis by lactamases Usually reserved for multi-resistant organisms Penetrates BBB well
59
Adverse reactions with Cephalosporins-Beta lactams
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
Carbapenem-Beta lactam MOA
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
Carbapenem-Beta lactam used for_____
Last line agents Intra-abdominal, resistant UTI’s, pneumonia
62
Carbapenem-Beta lactam most penetrate ______
BBB
63
Examples of Carbapenem-Beta lactam
Ertapenem (Invanz) Meropenem (Merrem) Imipenem (Primaxin)
64
Adverse reactions to Carbapenem-Beta lactam
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
Vancomycin MOA
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
Vancomycin most valuble against_______
Most valuable against blood-stream infection and endocarditis Caused by MRSA
67
Adverse reactions with vancomycin
Frequent Phlebitis at injection site Chills, fever Nephrotoxicity “red man” syndrome
68
Aminoglycosides MOA
Inhibit ribosomal proteins and cause mRNA to misread
69
Amionoglycosides are useful in
Significant post antibiotic effect Synergistic with Beta-lactams or vancomycin Especially useful in enterococcal endocarditis
70
Examples of aminoglycosides
Gentamycin
71
Adverse reactions for aminoglycosides
Ototoxicity Nephrotoxicity, In elderly, For more than 5 days, In renal insufficiency, With higher doses, Concurrent with loop diuretics Curare-like affect
72
Fluoroquinolone MOA
Inhibits bacterial DNA protein synthesis
73
Fluoroquinolone Used for
Excellent with gram – organisms UTI, bacterial diarrhea, bone/joint infections
74
Examples of Fluoroquinolone
Examples: Ciprofloxacin (Cipro) Levofloxacin (Levaquin)
75
Adverse reactions for Fluoroquinolone
N/V/D Prolongation of QT interval Cartilage damage/tendon rupture Renal insufficiency Concurrent steroid use Advanced age
76
Metronidazole MOA
Antiprotozoal /Anaerobic antibacterial Forms toxic byproducts that cause unstable DNA molecules
77
Metronidazole is indicated for
Indicated for: Intra-abdominal infections Vaginitis C-diff present as superinfections
78
Metronidazole other name
(Flagyl)
79
Adverse reactions for Metronidazole
Nausea Peripheral neuropathy In prolonged use Disulfiram-like effect With alcohol Flushing, dizziness, HA, chest/abd pain Hangover
80

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