Hospital Acquired Infections & Antibiotic Basics - EXAM 2

Question 1

What are 6 possible sources of HAI?

Answer 1

1. central line associated sepsis
2. urinary catheter associated
3. SSI
4. HAP
5. VAP
6. Cdiff

Question 2

What are 8 risk factors for developing HAI?

Answer 2

1. immunocompromised
2. infection control practices
3. prevalence of community pathogens
4. older age
5. longer hospital stays
6. critical care unit stays
7. multiple chronic illnesses
8. mech. vent support

Question 3

What are 3 possible transmission sources?

Answer 3

1. direct contact w/ healthcare worker
2. contaminated environment
3. extraluminal migration

Question 4

What are symptoms that suggest a pre-existing infection?

Answer 4

• fever, chills, night sweats
• AMS
• productive cough, SOB
• rebound tenderness
• suprapubic pain
• dysuria
• CVA tenderness

Question 5

V/S changes suggestive of infection

Answer 5

• HoTN, tachy
• tachypnea, low sats

Question 6

What lab values suggest organ dysfunction?

Answer 6

• increased lactic acid
• increased PT
• increased BUN/creat
• elevated WBC
• hypo/hyperglcyemia
• cultures

Question 7

When do SSIs typically occur?

Answer 7

• within 30 days

Question 8

Types of SSI

Superficial incisional:

Answer 8

• isolated to area of incision
• erythema
• easiest to treat

Question 9

Types of SSI

Deep incisional:

Answer 9

• beneath the incision area
• area in muscle & tissue surrounding muscle
• pus/elevated WBCs

Question 10

Types of SSI

Organ or space:

Answer 10

• area other than skin/muscle
• includes organs or space b/w organs
• difficult to treat - more powerful Abx & longer course

Question 11

Signs of SSI

Answer 11

• erythema
• pain
• warmth
• delayed healing
• fever
• drainage of pus
• swelling

Question 12

What are the 3 most common bacteria that lead to SSI?

Answer 12

1. Staphylococcus
2. Streptococcus
3. Pseudomonas

Question 13

Risk of SSI

What is a clean wound?

Answer 13

• not inflamed/contaminated
• does not involve organ

Question 14

Risk of SSI

What is a clean-contaminated wound

Answer 14

• no evidence of infection
• does involve an internal organ

Question 15

Risk of SSI

What is a contaminated wound?

Answer 15

• involves internal organ w/ spillage of contents
• ex: ruptured gallbladder/bowel

Question 16

Risk of SSI

What is a dirty wound?

Answer 16

• a wound w/ a known infection prior to surgery
• ex: MVA, trauma, stabbing

Question 17

Risk of SSI

What effect does surgery length have on risk?

Answer 17

• > 2 hrs = more risk

Question 18

Risk of SSI

What comorbidities can lead to increased risk?

Answer 18

• cancer, smoking, DM, overweight, immunocompromised

Question 19

Risk of SSI

Why are elderly @ increased risk?

Answer 19

• malnourished
• multi-organ issues

Question 20

Grading Categories for Prevention of SSI

Grade 1A:

Answer 20

• strongly recommend
• mod-high quality evidence
• ex: IV Abx

Question 21

Grading Categories for Prevention of SSI

Grade 1B:

Answer 21

• strongly recommend
• low quality of evidence

Question 22

Grading Categories for Prevention of SSI

Grade 1C:

Answer 22

• strong recommendation required by state/federal regulation

Question 23

Grading Categories for Prevention of SSI

Grade II:

Answer 23

• weak recommendation

Question 24

Guideline for prevention of SSI

Parenteral Abx
IB:

Answer 24

• admin when indicated (SCIP - pre-op IV)
• timed so Abx is established in tissue upon incision (usually w/i 30min)

Question 25

Guideline for the Prevention of SSI

non-parenteral Abx
IB recommendation:

Answer 25

• should not apply Abx ointment to incisions
• provider discretion

Question 26

Guidelines for the Prevention of SSI

Glycemic control
1A recommendation:

Answer 26

• intra-op and post-op BG < 200mg/dL

Question 27

Guidelines for the Prevention of SSI

Normothermia
1A recommendation:

Answer 27

• maintain normothermia peri-op helps reduce SSI

Question 28

Guidelines for the Prevention of SSI

Antiseptic prophylaxis
1A:
1B:
II:

Answer 28

• 1A: use of alcohol-based antiseptic intraop
• 1B: shower/bathe w/ soap or antiseptic pm before
• II: iodine irrigation in deep tissues intra-op

Question 29

Guidelines for the Prevention of SSI

Blood Transfusion
1B:

Answer 29

• don’t hold necessary transfusion from a surgical pt to try to prevent infection

Question 30

Guidelines for the Prevention of SSI

Immunosuppresives: Decadron
joint arthroplasty -

Answer 30

provider preference
* may lead to infection

Question 31

What is the main goal of antibiotic prophylaxis?

Answer 31

• adequate bactericidal concentration in serum and tissues by incision
• w/i 30min (ancef 15min)

Question 32

Abx prophylaxis

What is MIC?

Answer 32

Minimum inhibitory concentration
what needs to be in the tissues prior to incision & maintained throughout surgery

Question 33

Abx prophylaxis

What are the 5 general principles of Abx prophylaxis?

Answer 33

1. should work against common surgical wound pathogens (strep, staph)
2. proven efficacy in clinical trials
3. must achieve MIC in serum & tissues
4. shortest possible course effective
5. newer Abx reserved for resistant infections

Question 34

Abx prophylaxis

When should Abx be administered?

Answer 34

• within at least 1hr of incision - 30min better
• completely infused before tourniquet goes up
• may hold for cultures

Question 35

Abx Prophylaxis

What Abx can be given w/i 2 hrs of incision?

Answer 35

• Vancomycin
• Fluoroquinolones
• Clindamycin - not used as much b/c colitis & GI bleed

Question 36

Abx Prophylaxis

What do we do if the surgeon refuses Abx or they are on scheduled Abx?

Answer 36

• document
• Scheduled should be given in time frame - or they will need prophylaxis

Question 37

Abx prophylaxis

When should Abx be re-dosed?

Answer 37

1. 2 half-lives
2. excess bleeding
3. after cardiopulmonary bypass
4. drug dependent (2-4hrs)