Hospital Acquired Infections & Antibiotic Basics - EXAM 2 Flashcards
What are 6 possible sources of HAI?
- central line associated sepsis
- urinary catheter associated
- SSI
- HAP
- VAP
- Cdiff
What are 8 risk factors for developing HAI?
- immunocompromised
- infection control practices
- prevalence of community pathogens
- older age
- longer hospital stays
- critical care unit stays
- multiple chronic illnesses
- mech. vent support
What are 3 possible transmission sources?
- direct contact w/ healthcare worker
- contaminated environment
- extraluminal migration
What are symptoms that suggest a pre-existing infection?
- fever, chills, night sweats
- AMS
- productive cough, SOB
- rebound tenderness
- suprapubic pain
- dysuria
- CVA tenderness
V/S changes suggestive of infection
- HoTN, tachy
- tachypnea, low sats
What lab values suggest organ dysfunction?
- increased lactic acid
- increased PT
- increased BUN/creat
- elevated WBC
- hypo/hyperglcyemia
- cultures
When do SSIs typically occur?
- within 30 days
Types of SSI
Superficial incisional:
- isolated to area of incision
- erythema
- easiest to treat
Types of SSI
Deep incisional:
- beneath the incision area
- area in muscle & tissue surrounding muscle
- pus/elevated WBCs
Types of SSI
Organ or space:
- area other than skin/muscle
- includes organs or space b/w organs
- difficult to treat - more powerful Abx & longer course
Signs of SSI
- erythema
- pain
- warmth
- delayed healing
- fever
- drainage of pus
- swelling
What are the 3 most common bacteria that lead to SSI?
- Staphylococcus
- Streptococcus
- Pseudomonas
Risk of SSI
What is a clean wound?
- not inflamed/contaminated
- does not involve organ
Risk of SSI
What is a clean-contaminated wound
- no evidence of infection
- does involve an internal organ
Risk of SSI
What is a contaminated wound?
- involves internal organ w/ spillage of contents
- ex: ruptured gallbladder/bowel
Risk of SSI
What is a dirty wound?
- a wound w/ a known infection prior to surgery
- ex: MVA, trauma, stabbing
Risk of SSI
What effect does surgery length have on risk?
- > 2 hrs = more risk
Risk of SSI
What comorbidities can lead to increased risk?
- cancer, smoking, DM, overweight, immunocompromised
Risk of SSI
Why are elderly @ increased risk?
- malnourished
- multi-organ issues
Grading Categories for Prevention of SSI
Grade 1A:
- strongly recommend
- mod-high quality evidence
- ex: IV Abx
Grading Categories for Prevention of SSI
Grade 1B:
- strongly recommend
- low quality of evidence
Grading Categories for Prevention of SSI
Grade 1C:
- strong recommendation required by state/federal regulation
Grading Categories for Prevention of SSI
Grade II:
- weak recommendation
Guideline for prevention of SSI
Parenteral Abx
IB:
- admin when indicated (SCIP - pre-op IV)
- timed so Abx is established in tissue upon incision (usually w/i 30min)
Guideline for the Prevention of SSI
non-parenteral Abx
IB recommendation:
- should not apply Abx ointment to incisions
- provider discretion
Guidelines for the Prevention of SSI
Glycemic control
1A recommendation:
- intra-op and post-op BG < 200mg/dL
Guidelines for the Prevention of SSI
Normothermia
1A recommendation:
- maintain normothermia peri-op helps reduce SSI
Guidelines for the Prevention of SSI
Antiseptic prophylaxis
1A:
1B:
II:
- 1A: use of alcohol-based antiseptic intraop
- 1B: shower/bathe w/ soap or antiseptic pm before
- II: iodine irrigation in deep tissues intra-op
Guidelines for the Prevention of SSI
Blood Transfusion
1B:
- don’t hold necessary transfusion from a surgical pt to try to prevent infection
Guidelines for the Prevention of SSI
Immunosuppresives: Decadron
joint arthroplasty -
provider preference
* may lead to infection
What is the main goal of antibiotic prophylaxis?
- adequate bactericidal concentration in serum and tissues by incision
- w/i 30min (ancef 15min)
Abx prophylaxis
What is MIC?
Minimum inhibitory concentration
what needs to be in the tissues prior to incision & maintained throughout surgery
Abx prophylaxis
What are the 5 general principles of Abx prophylaxis?
- should work against common surgical wound pathogens (strep, staph)
- proven efficacy in clinical trials
- must achieve MIC in serum & tissues
- shortest possible course effective
- newer Abx reserved for resistant infections
Abx prophylaxis
When should Abx be administered?
- within at least 1hr of incision - 30min better
- completely infused before tourniquet goes up
- may hold for cultures
Abx Prophylaxis
What Abx can be given w/i 2 hrs of incision?
- Vancomycin
- Fluoroquinolones
- Clindamycin - not used as much b/c colitis & GI bleed
Abx Prophylaxis
What do we do if the surgeon refuses Abx or they are on scheduled Abx?
- document
- Scheduled should be given in time frame - or they will need prophylaxis
Abx prophylaxis
When should Abx be re-dosed?
- 2 half-lives
- excess bleeding
- after cardiopulmonary bypass
- drug dependent (2-4hrs)
